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Coarse tremor
33%
1/3
Auditory hallucinations
0%
0/3
Amenorrhea
Peripheral neuropathy
Dactylitis
67%
2/3
Select Answer to see Preferred Response
This is an African American patient who is presenting with anemia, polyuria, and an inability to concentrate her urine, suggesting the diagnosis of sickle cell disease/trait, which is associated with dactylitis. Hyposthenuria is the inability to concentrate the urine and commonly occurs in patients with sickle cell disease (SCD). The defect in urinary concentration is related to sickled erythrocytes that restrict blood flow in the renal medulla, impairing the kidney's ability to create a gradient needed to concentrate the urine. Both antidiuretic hormone generation and urinary diluting capacity remain unperturbed. In a patient with hypostheuria and polyuria that are caused by SCD, neither water deprivation nor desmopressin will result in a significant increase in urine osmolality. Other symptoms associated with SCD include fatigue, dactylitis, splenomegaly, priapism, and bone pain. Incorrect Answers: Answer 1: Coarse tremor is associated with lithium toxicity. Lithium toxicity can cause nephrogenic diabetes insipidus, which can result in similar responses to water deprivation and desmopressin as sickle cell disease patients have. However, lithium would not explain the low hemoglobin and hematocrit. Answer 2: Auditory hallucinations are positive symptoms of schizophrenia. Schizophrenia is a common underlying disorder associated with psychogenic polydipsia. In a water deprivation test, patients with psychogenic polydipsia would be able to concentrate their urine. Answer 3: Amenorrhea is associated with Sheehan’s syndrome. Sheehan’s syndrome is postpartum pituitary gland necrosis and is a cause of central diabetes insipidus. In a water deprivation test, patients with central DI would be able to concentrate their urine (by at least 50%) following the administration of desmopressin. Antidiuretic hormone levels would be low. Answer 4: Peripheral neuropathy can occur with chronic or uncontrolled diabetes mellitus. Patients with diabetes mellitus may complain of polydipsia and polyuria; however, they do not lose their ability to concentrate urine. In fact, some patients may experience hypersthenuria caused by the presence of glucose in the urine. Bullet Summary: Hyposthenuria is associated with sickle cell disease and presents with frequent urination due to an inability to concentrate urine.
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