CASE STUDY 5 Christiane Mariah Ally Kayla Case

CASE STUDY 5 Christiane, Mariah, Ally, Kayla

Case Study 5 ■ A 9 -year-old male is brought in by his mother because he is complaining of constant thirst and frequent urination. The problem is so bad that the boy is having trouble sleeping because he is constantly getting up to use the bathroom. A few times, he has even wet the bed. The mother suspects that something may be wrong with his pituitary gland as there is a family history of pituitary problems. Microscopic analysis of his urine does not reveal anything abnormal.

Urinalysis ■ During the urinalysis we found that our patient had a relatively normal outcome with the only abnormalities being the p. H and presence of ketones. ■ The urine was nearly colorless and clear; p. H was approximately 6; specific gravity, protein, glucose, were all within the normal range; there was a slight presence of ketones (. 5); erythrocytes and leukocytes were not present.

Diagnosis ■ Ketones are a by-product of fat when it is broken down by the body; the presence of ketones indicated to us that his body was using fat as a source of energy rather than glucose. This would further indicate to us that his body wasn’t using insulin properly. ■ The child also has a familial history of pituitary gland disorders so this further helped to conclude that he has DI rather than diabetes 1/2. ■ DI is a rare form of diabetes that affect the pituitary gland by suppressing the hormone vasopressin.

Diabetes Insipidus (DI) ■ When the body produces those ketones it is because it is using fat as energy instead of glucose – ketones are a byproduct of broken down fat. ■ Symptoms include: frequent urination, constant thirst, wetting the bed, and fatigue. ■ Di affects the nervous system and urinary system due to the lack of vasopressin in the body. ■ It also affects the circulatory system through blood pressure and sodium levels if your drink too many fluids or take too much medication (desopressin).

Further Testing ■ Water deprivation test: you can’t drink water for several hours and the doctor or technician will hourly test your blood and urine over the course of x hours. ■ MRI: this would show any tumors or abnormalities in the brain that would further show problems with the pituitary or snuff other possible diagnoses.

Treatment ■ Desopressin (taken by mouth of nose): this eliminates excess urination as it is a synthetic hormone used in the place of vasopressin. ■ In more mild cases you just need to increase water consumption. Drink as much, if not more, water than urine being released. ■ Low protein/sodium diet will keep the urine production at bay. ■ Due the rarity of the condition not many treatments are available.

Other possible diagnoses ■ Pituitary adenoma (benign tumor): the family has a history of pituitary gland problems so it was no our of the question when it came to the diagnosis of the patient. It was first thought that he could have a tumor pressing on his pituitary but this diagnosis came with other