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18 December 2020: Articles

Masked Diabetes Insipidus Hidden by Severe Hyponatremia: A Case of Pituitary Metastasis of Lung Adenocarcinoma

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy , Educational Purpose (only if useful for a systematic review or synthesis)

Miki Watanabe A , Junichi Yasuda C , Kenji Ashida A* , Yuko Matsuo C , Ayako Nagayama C , Yuka Goto C , Shimpei Iwata C , Masayuki Watanabe C , Jun Sasaki B , Tomoaki Hoshino C , Masatoshi Nomura A

DOI: 10.12659/AJCR.928113

Am J Case Rep 2020; 21:e928113

Table 2. Results of laboratory examinations before and after desmopressin (DDAVP) initiation.

ParametersValueReference range
Before DDAVPAfter DDAVP
  Aspartate aminotransferase (IU/L)482613–30
  Alanine aminotransferase (IU/L)66297–30
  γ-glutamyl transpeptidase (IU/L)29299–32
  Blood urea nitrogen (mg/dL)20218–21
  Creatinine (mg/dL)0.820.480.65–1.07
  Sodium (mmol/L)149143138–145
  Potassium (mmol/L)3.533.6–4.8
  Chlorine (mmol/L)109104101–108
  Urine osmolality (mOsm/kg•HO)213N.A.50–1300
  Urine specific gravity1.0061.0151.006–1.030
  Plasma renin activity (ng/mL/h)≤0.1N.A.0.2–2.3
  Active renin concentration (pg/mL)≤2.0≤0.11.2–35.4
  Arginine vasopressin (pg/mL)0.5
  Plasma osmotic pressure (mOsm/kg•HO)300289275–290
High plasma osmolality with low level of arginine vasopressin was noted, and the patient was diagnosed with central diabetes insipidus. DDAVP treatment increased urine osmolality and specific gravity and decreased the plasma osmotic pressure and serum sodium concentration.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923