Central diabetes insipidus: clinical profile and factors indicating organic etiology in children.

OBJECTIVE

To evaluate the profile of children with central diabetes insipidus (DI) and identify factors indicating organic etiology.

DESIGN

Retrospective chart review.

SETTING

Tertiary referral hospital.

SUBJECTS: Fifty-nine children with central DI (40 boys, 19 girls).

METHODS

Features of organic and idiopathic central DI were compared using students t test and chi square test. Odds ratio was calculated for factors indicating organic etiology.

RESULTS

Diagnosis included post-operative central DI (13, 22%), central nervous system (CNS) malformations (5, 8.6% holoprosencephaly 4 and hydrocephalus 1), histiocytosis (11, 18.6%), CNS pathology (11, 18.6%; craniopharyngioma 3, empty sella 2, germinoma 2, neuro-tuberculosis 2, arachnoid cyst 1 and glioma 1) and idiopathic central DI (19, 32.2%). Children with organic central DI were diagnosed later (7.8+/- 3.1 years against 5.3+/-2.4 years, P=0.03) and had lower height standard deviation score (-2.7+/-1.0 versus -1.0+/- 1.0, P<0.001) compared to idiopathic group. A greater proportion of children with organic central DI had short stature (81.8% against 10.5%, P <0.001, odds ratio 38.25), neurological features (45.5% against 0%, p 0.009) and anterior pituitary hormone deficiency (81.8% against 5.3%, P<0.001, odds ratio 81) compared to idiopathic group. A combination of short stature and onset after five years of age led to discrimination of organic central DI from idiopathic group in all cases.

CONCLUSION

Organic central DI should be suspected in children presenting after the age of five years with growth retardation and features of anterior pituitary deficiency.