• 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)—due to renal cells in the kidneys not responding to ADH

    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, tumor, or head injury
    • Certain conditions (eg, sarcoidosis, tuberculosis, granulomatosis with polyangiitis)
    • Certain medicines (eg, lithium)—the most common cause of diabetes insipidus
    • Kidney disease (eg, polycystic kidney disease)
    • Protein malnutrition
    • Certain conditions (eg, 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.

    RESOURCES

    American Diabetes Association http://www.diabetes.org/

    Nephrogenic Diabetes Insipidus Foundation http://www.ndif.org/

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca/

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

    References

    Central diabetes insipidus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 1, 2011. Accessed July 31, 2012.

    Garofeanu CG, Weir M, Rosas-Arellano MP, et al. Causes of reversible nephrogenic diabetes insipidus: a systematic review. Am J Kidney Dis . 2005;45:626-37.

    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://www.ebscohost.com/dynamed/what.php . 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, Willson TA. The management of central diabetes insipidus in infancy: desmopressin, low renal solue load formula, thazide diuretics. J Pediatr Endocrinol Metab. 2007;20:459-69.

    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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