Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report |
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Authors: | Elaine L. Rosen MD Apisadaporn Thambundit MD Philip S. Mehler MD Steven D. Mittelman MD PhD |
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Affiliation: | 1. Division of Adolescent Medicine, Department of Pediatrics, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine, UCLA, Los Angeles, California;2. Division of Endocrinology, Department of Pediatrics, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine, UCLA, Los Angeles, California;3. Eating Recovery Center, Denver, Colorado Department of Medicine, University of Colorado, ACUTE at Denver Health, Denver, Colorado |
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Abstract: | Anorexia nervosa (AN) has been associated with a multitude of hypothalamic pituitary abnormalities, although it is unknown which aberrations reflect disease causation and which are the consequences of severe malnutrition. Among these endocrinopathies, hypothalamic–posterior pituitary aberrations have been described, including disorders of osmoregulation. We report the case of an adolescent female with a history of severe AN, restricting subtype, treated aggressively with multiple hospitalizations. During hospitalization for severe weakness and lethargy, her course of medical stabilization was complicated by significant polyuria, ultimately diagnosed as central diabetes insipidus (DI). This is the first reported case, to our knowledge, of a severely malnourished adolescent with AN—restricting subtype developing central DI during the refeeding process for medical stabilization, thus adding to the small body of existing literature on disordered osmoregulation in this patient population. This case report raises the question as to whether the frequency of central DI during refeeding is greater than that previously recognized. Additional research should focus on how neuroendocrine dysregulation of water balance might impact the clinical course of AN and its treatment. |
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Keywords: | anorexia nervosa antidiuretic hormone (ADH) arginine vasopressin (AVP) diabetes insipidus osmoregulation refeeding |
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