Absent Thirst and Diabetes Insipidus

Individuals with diabetes insipidus who have an absent thirst mechanism can be challenging to manage, and are at increased risk of sodium derangements compared with those who have intact thirst. While adipsia can be associated with multiple underlying causes of DI, it occurs most commonly in patients following pituitary surgery, particularly after craniopharyngioma removal. The diagnosis can typically be made based on historical questions or following an episode of hypernatremia without a reported increase in thirst from the patient. Management includes increased home monitoring of body weight, fluid intake and output, and more frequent laboratory sodium monitoring. While the use of handheld blood analyzers to monitor sodium levels at home is not FDA-approved or commonplace, this can be useful in patients who are otherwise difficult to manage.