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Neuroendocrinology and Pituitary

MON-002 - New-Onset Central Diabetes Insipidus in an Elderly Woman without Predisposing Risk Factors

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Location: ENDOExpo; Poster Floor

    Submitting author(s)

  • George Altarcha, MD

    MD
    COMMUNITY MEDICAL CENTER
    Toms River, NJ, United States

    • Abstract Poster Presenter(s)

  • George Altarcha, MD

    MD
    COMMUNITY MEDICAL CENTER
    Toms River, NJ, United States

    • Senior Author/Primary Investigator(s)

  • NP

    NIKUNJKUMAR PATEL, MD

    Endocrinologist Attending
    Oceans Prime Diabetes and Endocrinology
    Toms River, New Jersey, United States

Disclosure(s):
George Altarcha, MD: No financial relationships to disclose
Background
Diabetes insipidus (DI) is a rare cause of polyuria and polydipsia and is typically associated with pituitary disease, neurosurgery, trauma, or lithium exposure. In elderly patients, symptoms are frequently misattributed to aging or diabetes mellitus, leading to delayed diagnosis and risk of severe hypernatremia.
Case
A 72-year-old woman with hypertension and hyperlipidemia presented with two months of progressive thirst, dry mouth, and nocturia, drinking nearly one gallon of water daily. Symptoms worsened with nausea and decreased oral intake. She denied head trauma, pituitary disease, malignancy, psychiatric illness, or lithium exposure.
Laboratory evaluation revealed hypernatremia with inappropriately dilute urine: serum sodium 150 mEq/L, urine osmolality 134 mOsm/kg, urine sodium < 20 mEq/L, and urine creatinine 18.6 mg/dL. Despite hypernatremia, failure to concentrate urine indicated impaired antidiuretic hormone (ADH) activity. After desmopressin administration, urine osmolality increased to 361 mOsm/kg (>160% rise), confirming preserved renal responsiveness and establishing central diabetes insipidus (CDI). Her hypernatremia and symptoms improved with DDAVP.
MRI of the pituitary demonstrated abnormal homogeneous pituitary stalk thickening to 5 mm without focal nodularity, raising concern for inflammatory lymphocytic hypophysitis.
Conclusion
This case highlights new-onset CDI in an elderly patient without classic risk factors. Hypernatremia with hypotonic urine and a robust desmopressin response rapidly established the diagnosis. MRI findings suggest inflammatory or infiltrative pituitary pathology as a potential etiology. Clinicians should maintain a high index of suspicion for DI in older adults with polyuria and polydipsia to prevent severe dehydration and neurologic complications.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*