Diabetes Insipidus

Definition

Diabetes insipidus is a condition where water in the body is improperly removed from the circulatory system by the kidneys.

There are two forms of diabetes insipidus (DI):

  • Central diabetes insipidus (central DI)
  • Nephrogenic diabetes insipidus (NDI)

Causes

Antidiuretic hormone (ADH) controls the amount of water reabsorbed by the kidneys. ADH is made in the hypothalamus of the brain. The pituitary gland, at the base of the brain, stores and releases ADH.

Central DI occurs when the hypothalamus does not make enough ADH.

NDI occurs when the kidneys do not respond to ADH.

Some diabetes insipidus is casued by genetic problems that lead to central DI or NDI. Others may develop after an injury or illness.

Pituitary Gland
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Risk Factors

Factors that may increase your risk of diabetes insipidus include:

  • Damage to the hypothalamus or pituitary glands due to surgery, infection, stroke, tumor , or head injury
  • Certain conditions (such as sarcoidosis , tuberculosis , granulomatosis with polyangiitis)
  • Certain medicines (such as lithium)—the most common cause of diabetes insipidus
  • Kidney disease (such as polycystic kidney disease )
  • Protein malnutrition
  • Certain conditions (such as hypercalcemia, hypokalemia)

Symptoms

Symptoms may include:

  • Increased urination, especially during the night
  • Extreme thirst
  • Dehydration (fast heart rate, dry skin and mouth)

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam may be done.

Tests may include the following:

  • Blood tests
    • Electrolyte levels
    • Kidney function tests
    • ADH levels
    • Blood sugar to look for diabetes mellitus
  • Urinalysis
    • Urine specific gravity and/or osmolality (measures how concentrated or dilute the urine is)
    • Urine volume tests to see how much urine is being produced
  • Water deprivation test
    • Only done under doctor supervision
    • Urine output is measured for a 24-hour period
  • Magnetic resonance imaging (MRI) of the head—if central CDI is suspected

Treatment

Talk with your doctor about the best plan for you. Your doctor will work with you to address the underlying cause.

Treatment may include:

  • For central DI—taking a synthetic form of ADH
  • For NDI—following a low-sodium diet, drinking plenty of water, taking a diuretic (water pill)

Prevention

There are no known ways to prevent diabetes insipidus. Talk to the doctor right away if you have excessive urination or thirst.

Revision Information

  • American Diabetes Association

    http://www.diabetes.org

  • Nephrogenic Diabetes Insipidus Foundation

    http://www.ndif.org

  • Canadian Diabetes Association

    http://www.diabetes.ca

  • Health Canada

    http://www.hc-sc.gc.ca/index%5Fe.html

  • Central diabetes insipidus. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us . Updated September 1, 2011. Accessed July 31, 2012.

  • Garofeanu CG, Weir M, et al. Causes of reversible nephrogenic diabetes insipidus: a systematic review. Am J Kidney Dis . 2005;45:626-637.

  • Majzoub JA, Srivatsa A. Diabetes insipidus: clinical and basic aspects. Pediatr Endocrinol Rev . 2006;Suppl 1:60-65.

  • Nephrogenic diabetes insipidus. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us . Updated September 1, 2011. Accessed July 31, 2012.

  • Patient information publications: diabetes insipidus. NH Clinical Center website. Available at: http://www.cc.nih.gov/ccc/patient%5Feducation/pepubs/di.pdf . Published 2006. Accessed July 31, 2012.

  • Rivkees SA, Dunbar N, et al. The management of central diabetes insipidus in infancy: desmopressin, low renal solue load formula, thazide diuretics. J Pediatr Endocrinol Metab . 2007;20:459-469.

  • Sands JM, Bichet DG. Nephogenic diabetes insipidus. Annals Int Med . 2006;144:186-194.

  • Toumba M, Stanhope R. Morbidity and mortality associated with vasopressin analogue treatment. Pediatr Endocrinol Metab . 2006;19:197-201.

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