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Endocrinol Nutr 2007;54:23-33 - DOI: 10.1016/S1575-0922(07)71402-X
Guía clínica del diagnóstico y tratamiento de los trastornos de la neurohipófisis
Clinical practice guideline for the diagnosis and treatment of neuropituitary disorders
Miguel Català Bauset, Alberto Gilsanz Peral, Frederic Tortosa Henzi, Ana Zugasti Murillo, Basilio Moreno Esteban, Irene Halperin Ravinovich, Tomás Lucas Morante, Gabriel Obiols Alfonso, Concecpción Páramo Fernández, Antonio Picó Alfonso, Carlos del Pozo Picó, Elena Torres Vela, César Varela da Costa, Susan Webb Youdale, Carlos Villabona Artero??,
Grupo de Trabajo de Neuroendocrinología de la Sociedad Española de Endocrinología y Nutrición
Recibido 24 octubre 2006, Aceptado 13 noviembre 2006

Body fluid homeostasis is regulated by water intake, which depends mainly on thirst and urine excretion mainly modulated by arginine vasopressin (AVP). In the absence of AVP, the collecting tubule is impermeable to water diffusion, giving rise to water diuresis with a urinary osmolality of less than 100mOsm/Kg. In contrast, in the presence of AVP, permeability is considerably increased, water is reabsorbed free of solutes, and urinary osmolality is above 1000mOsm/Kg.

Diabetes insipidus results from an alteration in body water due to inadequate AVP release (central or neurogenic diabetes insipidus) or to a lack of AVP activity in the renal collecting tubule (nephrogenic diabetes insipidus). The syndrome is characterized by polyuria with excretion of large volumes of urine (>3.5L/day), polydipsia, and general symptoms. The etiology of central diabetes insipidus can be familial but this disease is more frequently caused by acquired forms after hypothalamic-pituitary surgery, head injuries, tumors, granulomas, and idiopathic and other forms. Nephrogenic diabetes insipidus can be produced by genetic, familial, or acquired forms secondary to drugs, metabolic alterations, and other factors.

Diagnostic tests in polyuric states include baseline evaluation with simultaneous determination of plasma and urinary osmolality and, if these tests are inconclusive, the water deprivation test allows symptoms of potomania and diabetes insipidus, whether central of nephrogenic, to be distinguished. Diagnosis of neurogenic diabetes insipidus requires hypothalamic-pituitary magnetic resonance imaging and hormonal study of the anterior pituitary gland. The treatment of choice for central diabetes insipidus is the vasopressin analog, desmopressin. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) results from non-physiological AVP secretion and is characterized by the presence of hyponatremia due to impaired free water excretion. This syndrome can be caused by tumors, neurological processes, pulmonary disease, and drugs. Diagnosis is based on findings of hyponatremia with plasma hypoosmolality, elevated urine osmolality, absence of volume depletion states and hypervolemia, and normal renal, adrenal, and thyroid function. Treatment consists of water restriction in mild and moderate hyponatremia. Hypertonic saline is required in severe hyponatremia.

Palabras clave
Metabolismo del agua, Diabetes insípida, Secreción inadecuada de ADH
Key words
Water metabolism, Diabetes insipidus, Inappropriate ADH secretion
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Correspondencia: Dr. C. Villabona Artero. Servei d’ Endocrinologia i Nutrició. Hospital Universitari de Bellvitge. Feixa Llarga, s/n. 08907 L’ Hospitalet de Llobregat. Barcelona. España.
Copyright © 2007. Sociedad Espa??ola de Endocrinolog??a y Nutrici??n