Assessment and Treatment of Nocturia in Endocrine Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus

Context: Salt and water homeostasis is regulated hormonally, so polyuria can result from endocrine disease directly or via secondary effects. These mechanisms are not con-sistently considered in primary care management of nocturia. Objective: To conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management. Evidence acquisition: Four databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screen -ing, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT). Evidence synthesis: Twelve studies focused on mechanisms of nocturia, while two eval-uated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, cal-cium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentra-tion >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morn-ing urine osmolarity <600 mOsm/l after overnight fluid avoidance. Conclusions: Endocrine disease can result in nocturia via varied salt and water regula-tion pathways. The aim of management is to identify and treat causative factors, but sec-ondary effects can restrict improvements in nocturia.