SFEBES2021 Poster Presentations Neuroendocrinology and Pituitary (47 abstracts)
Management of cranial Diabetes Insipidus in a tertiary centre – clinical outcomes and patient perception of care
MDSA Dilrukshi 1 , Marcus Vickars 1 , Christine May 1 , Taffy Makaya 2 , Fiona Ryan 2 , Bahram Jafar Mohammadi 1 , John Wass 1 , Aparna Pal 1 & Aoife Garrahy 1
11Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals, Oxford, United Kingdom; 2Department of Paediatric Endocrinology, Oxford University Hospitals, Oxford, United Kingdom
There is growing recognition within Endocrinology physician and patient groups of morbidity and mortality in association with prescribing errors and dysnatraemia, in hospitalised patients with cranial diabetes insipidus (CDI). The aims of this study were firstly, to assess outcomes in hospitalised patients with CDI by review of electronic records from 2012-2021, and secondly, to assess the same patient cohort’s perceptions of their care via telephone questionnaire. 109 patients were included (59 female), median age 42 (6-80) years. Median duration of CDI was 11(1-39) years. Aetiology of CDI included hypothalamic-pituitary tumours (46%), post-pituitary surgery (18%) and infiltrative disorders (16%). Route of desmopressin was oral in 83% of patients. There were 85 admissions (66% emergency) to OUH in 38 patients, median length of stay 3(1-16) days. Daily measurement of serum sodium was performed in 39% of admissions; hyponatraemia and hypernatraemia occurred in 44% and 15% of admissions respectively. Endocrine consultation was sought in 63% of admissions post-2018. 78 patients (71%) completed the questionnaire.45 patients (58%) self-reported one or more hospital admission since the diagnosis of CDI. Of these, 53% felt their medical team did not have a good understanding of the management of CDI during hospital admission. 24% reported delay in administration of desmopressin, while 44% reported confusion between CDI and diabetes mellitus, often leading to blood glucose monitoring. 33% reported difficulty sourcing desmopressin from their community pharmacy. 23% recalled a history of hyponatraemia, while 38% delayed or skipped a dose of desmopressin once weekly to allow aquaresis. Dysnatraemia is common in hospitalised patients with CDI. More than half of patients perceived their medical team’s understanding of CDI to be poor when admitted with intercurrent illness. A coordinated approach, including education of non-specialist hospital staff, consideration of renaming of diabetes insipidus to avoid confusion, and early involvement by specialists, is needed to address this.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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