Diabetes insipidus and SIADH Quiz: Ace Your Exams

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A 36-year-old man comes to the clinic because of increased urination and thirst for the past three months. He mentions that he urinates approximately 10 times per day, including 3-4 times at night, and he drinks about 6 liters of water per day. Past medical history is noncontributory, and the patient does not take any medications. Vitals are within normal limits. Physical examination is unremarkable. Laboratory studies are as follows:  
 
Laboratory value Result 
Sodium  150 mEq/L 
 Serum osmolality  309 mOsmol/kg 
 Urine osmolality  187 mOsmol/kg 

There is inadequate change in the values after two hours of water deprivation. Desmopressin (antidiuretic hormone analog) is then administered. Laboratory studies one hour later revealed serum osmolality of 282 mOsmol/kg and urine osmolality of 500 mOsmol/kg. Which of the following is the most likely diagnosis?

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