Page 189 - Abstract Book KONIKA 18

Endocrinology

P-ENDO-025
Central Diabetes Insipidus in an 8-year-old Boy: A Case Report

Tita N Manurung, Muhammad Faizi, Nur Rochmah
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr. Soetomo General Hospital,
Surabaya, East Java, Indonesia
Abstract
Background Diabetes insipidus is a rare disorder, characterized by the excretion of abnormally large volume
of diluted urine (polyuria) and increased fluid intake (polydipsia). The most frequent cause is central DI
(CDI), which is the result of inadequate secretion of the anti-diuretic hormone. Polyuria is a very common
clinical dilemma often not worked up systematically. Early and accurate diagnosis are crucial for effective
treatment to improve quality of life as it requires long-term follow-up. Objective To present a case central
diabetes insipidus in child and its diagnostic approach Case An eight-year-old boy with polyuria, polydipsia,
and nocturia in the last 2 months before. Low urine specific gravity 1.002 and normal blood sugar level.
Diuresis rate was 22.5 ml/kg/hour and water intake about 6.7 L/day. Water deprivation test and desmopressin
test was performed to differentiate nephrogenic diabetes insipidus, central diabetes insipidus or primary
polydipsia. The diagnosis of CDI was confirmed by his inability to concentrate urine after a water deprivation
test followed by an increase in urine osmolality (35 to 365 mOsm/L) decreased urine production (22.5 ml/
kg/h to 4 ml/kg/h), decreased serum osmolality (305 to 298 mOsm/L) following intranasal administration
of desmopressin. Brain magnetic resonance imaging is recommended in CDI and revealed small pituitary
size. After oral desmopressin administration, the symptoms disappeared. Conclusion Polyuria, polydipsia,
urine production, urine specific gravity, water deprivation test, desmopressin test and brain MRI contrast
enabled us to diagnose CDI.
Keywords: desmopressin test; water deprivation test; polyuria; polydipsia; central diabetes insipidus

P-ENDO-026
Congenital Adrenal Hyperplasia in Male Infant with Adrenal Crisis: a Case
Report

Rianda Azarina, Muhammad Faizi, Nur Rochmah
Department of Child Health, Faculty of Medicine Universitas Airlangga/Dr.Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia
Abstract
Background Male with Congenital Adrenal Hyperplasia (CAH) is more likely to not be clinically diagnosed
earlier. Affected male infants without a sign of genital ambiguous are particularly prone to the occurrence
of adrenal crisis. The misdiagnose or delayed in treatment of CAH in males contributes significantly to
morbidity and early death. Objective To report a case and increase the awareness of CAH in male infant
with adrenal crisis Case A 40 days-old male infant was brought to Emergency Department with vomiting,
shortness of breath, poor feeding, drowsiness, and weight loss. The physical examination revealed
hypotension, signs of dehydration, and hyperpigmentation on the areola and external genital. The laboratory
results were hyponatremia, hyperkalemia, and metabolic acidosis. The diagnosis was confirmed by clinical
manifestations and elevated 17- OH Progesterone (17-OHP). The management was treating the dehydration
and administering hydrocortisone in stress dose. Maintenance dose hydrocortisone, fludrocortisone and
sodium chloride supplementation was given as maintenance therapy. The patient continues taking therapy
daily and has never developed into adrenal crisis since then. Conclusion The possibility of CAH has to be
considered when vomiting, signs of dehydration, malnutrition, and hyperpigmentation is present in male
infants. Good compliance in therapy will obtain optimal growth and development.
Keywords: congenital adrenal hyperplasia; adrenal crisis; male infant; 17-OHP

KONIKA XVIII Abstract Book 141