Conditions causing central diabetes insipidus (DI) may also cause cerebral salt wasting (CSW). It is possible that both conditions may be present at the same time.


When to suspect concurrent central DI and CSW:

(1) presence of an intracerebral process capable of causing central DI and CSW

(2) serum hyponatremia in the setting of central DI

(3) polyuria with natriuresis and decreased extracellular volume associated with dDAVP or pitressin administration


The differential diagnosis for the hyponatremia is iatrogenic SIADH with the central DI treated with excessive dDAVP or pitressin, but this would not be associated with polyuria or decreased extracellular volume.


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