Intracranial pathologies associated with central diabetes insipidus in infants

Clinical and pathophysiological aspects of impaired water and sodium metabolism in newborns and neurological complication

This literature review covers the pathophysiological features of water and sodium exchange in newborns. The main mechanisms regulating fluid and electrolyte balance in newborns are poorly studied. The volume and composition of the extracellular fluid are provided by the functional activity of the kidneys under the control of the neuroendocrine system. The antidiuretic hormone plays the main role in the regulation of water excretion by the kidneys. The volume of intracellular fluid depends on the passive water transport with the participation of aquaporins. Lability of water and electrolyte metabolism in newborns may be accompanied by hyponatremia. For various pathological conditions in the neonatal period, certain types of hyponatremias are characteristic. Correction of hyponatremia should be carried out taking into account its pathophysiological type. Hyponatremia is a common complication associated with severe neonatal brain damage. Hyponatremia contributes to brain damage as an independent factor. The study of indicators of water and electrolyte balance in the neonatal period has an important prognostic value for early detection of damage to the central nervous system.

Hydranencephaly complicated by central diabetes insipidus: report of two cases and systematic review of literature

PURPOSE

Hydranencephaly is a congenital condition characterized by the complete or near-complete absence of the cerebral cortex and basal ganglia, while central diabetes insipidus (CDI) is a condition characterized by the inability to concentrate urine due to a deficiency in antidiuretic hormone (ADH). CDI is known to occur in midline congenital malformations such as holoprosencephaly and septo-optic dysplasia, but its association with hydranencephaly is less well-established.

METHODS

We reported two cases of hydranencephaly complicated by CDI. We also performed a systematic review of the SCOPUS and PubMed databases for case reports and case series of patients with hydranencephaly and CDI, and compiled data on the clinical features and treatment options.

RESULTS

Seven cases of hydranencephaly complicated by CDI were identified from the systematic review in addition to the two cases reported here, resulting in a total of nine cases. The patients' age ranged from 4 days to 4 years, and there was a female sex predilection (3.5:1). Patients most commonly presented with macrocephaly, developmental delay, and seizures, with dysmorphic features noted in 33%. In addition to CDI, other endocrinologic derangements included hypothyroidism (22%), hypocortisolemia (22%), and panhypopituitarism (22%). CDI was treated using sublingual or oral desmopressin while hypopituitarism was treated with the appropriate hormone replacement therapy. Insertion of a ventriculoperitoneal (VP) shunt was reported in 44% of cases.

CONCLUSION

The case reports and systematic review suggest a previously unknown association between hydranencephaly and CDI. Clinicians managing cases of hydranencephaly are advised to have a high index of suspicion for CDI in patients presenting with the characteristic signs and symptoms.