282 NEUROGENIC DIABETES INSIPIDUS IN NEWBORN INFANTS ASSOCIATED WITH CNS ABNORMALITIES

Abstract

The clinical syndrome of neurogenic diabetes insipidus (DI) has recently been observed in three neonates. All cases were the products of complicated labors and deliveries and manifested symptoms of DI in the first 72 hours of life. Associated CNS abnormalities included metabolic encephalopathy, hemorrhage and cerebral hypoxia. Multiple quantitative measurements of serum antidiuretic hormone (ADH), during water deprivation with simultaneous urine and serum osmolalities and measurements of serum sodium, support the neurogenic form of DI.

Normal anterior pituitary function has been demonstrated in all cases by measurements of other trophic hormones and their products. These include serum TSH, T₄, cortisols and growth hormone. Hypothalamic dysfunction is strongly suggested by abnormal patterns of growth hormone release to L-Dopa, elevated basal serum prolactin levels and abnormal prolactin response with normal TSH response to intravenous thyrotropin releasing hormone (TRH).

This syndrome has been transient in one neonate, with clinical resolution of the DI and accompanying normal serum ADH levels. The DI has responded to treatment with parental pitressin as well as intranasal 1-Desamino-8-D-Arginine vasopressin (DD-AVP). We believe the syndrome of neurogenic DI may be considerably more common in neonates with CNS abnormalities than has previously been reported.

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