Diabetes Insipidus
Valerie Puorto
processing.... Drugs & Diseases > Endocrinology Diabetes Insipidus Updated: Jan 20, 2022
- Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more...
- Share Print Feedback
- Facebook Twitter LinkedIn WhatsApp Email
- Sections Diabetes Insipidus
- Overview
- Practice Essentials
Background Etiology Epidemiology Prognosis Show All
- Presentation
- History
- Workup
- Approach Considerations
- Treatment
- Approach Considerations
- Medication
- Medication Summary
Osmoreceptors for thirst are solute specific, responding preferentially to increased sodium levels in the ECF. Thus, elevated glucose levels in diabetes mellitus do not induce thirst; rather, the increased thirst in uncontrolled diabetes mellitus is secondary to volume depletion from osmotic diuresis.
Craniopharyngioma is a benign tumor that arises from squamous cell nests in the primitive Rathke pouch. It is the most frequent pediatric intracranial neoplasm, accounting for nearly 54% of cases. Central DI insipidus and multiple pituitary hormone deficiencies are common manifestations in childhood craniopharyngiomas. Surgery is the preferred treatment.
A retrospective study by Andereggen et al found that in patients who underwent craniopharyngioma surgery, the presence of postoperative diabetes insipidus was an independent risk factor for hypothalamic obesity (odds ratio 15.2). [8]
Diabetes insipidus (DI), also called water diabetes, is a condition marked by increased thirst and urination. It is not to be confused with the more common type of diabetes, diabetes mellitus (sugar diabetes). Four underlying conditions can lead to DI.
Diabetes insipidus (DI) is a disorder characterized by excretion of large amounts of hypotonic urine. Central DI results from a deficiency of the hormone arginine vasopressin (AVP) in the pituitary gland or the hypothalamus, whereas nephrogenic DI results from resistance to AVP in the kidneys. Central and nephrogenic DI are usually acquired, but genetic causes must be evaluated, especially if symptoms occur in early childhood. Central or nephrogenic DI must be differentiated from primary polydipsia, which involves excessive intake of large amounts of water despite normal AVP secretion and action. Primary polydipsia is most common in psychiatric patients and health enthusiasts but the polydipsia in a small subgroup of patients seems to be due to an abnormally low thirst threshold, a condition termed dipsogenic DI. Distinguishing between the different types of DI can be challenging and is done either by a water deprivation test or by hypertonic saline stimulation together with copeptin (or AVP) measurement. Furthermore, a detailed medical history, physical examination and imaging studies are needed to ensure an accurate DI diagnosis. Treatment of DI or primary polydipsia depends on the underlying aetiology and differs in central DI, nephrogenic DI and primary polydipsia.
Diabetes insipidus is a rare condition that occurs when the kidneys are unable to conserve water during the process of filtering blood. This form of diabetes is different than diabetes mellitus or "sugar" diabetes. Both forms of diabetes are associated with excessive urination, but have different causes and treatments.
Diabetes insipidus is caused by a lack of antidiuretic hormone (ADH), also called vasopressin, which prevents dehydration, or the kidney's inability to respond to ADH. ADH enables the kidneys to retain water in the body. The hormone is produced in a region of the brain called the hypothalamus. It is stored and released from the pituitary gland, a small gland at the base of the brain.
When the condition is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus, which may be inherited. This form of the disease involves a kidney defect that prevents the body from reabsorbing water back into the bloodstream. It is the rarest form of this uncommon disease.
We treat this condition with a medication called desmopressin acetate, or DDAVP. The medication is similar to antidiuretic hormone, the hormone implicated in diabetes insipidus. We will adjust the dosage for each individual to find the right balance between controlling symptoms and avoiding complications. Our goal is to help our patients return to healthy, normal lives.
The primary symptoms of diabetes insipidus are excessive thirst and excessive urination, sometimes as often as every 15 minutes. This is caused by the lack of antidiuretic hormone (ADH), also called vasopressin, or the inability of the kidneys to respond to ADH.
To diagnose diabetes insipidus, your doctor will ask you questions about your health and that of other family members, particularly if your doctor suspects you have the inherited form of the disease. Tests that may be administered include:
Dr. Kelly Wood is an ABMS board certified endocrinologist and internal medicine physician who treats adults with diabetes, thyroid disease, osteoporosis, and other hormonal conditions. She achieved her fellowship in endocrinology from University of Wisconsin Hospital and Clinics.
A healthy adult will typically urinate between 1 and 3 quarts (946.4 milliliters to 2.84 liters) of urine a day. People with diabetes insipidus may eliminate as many as 20 quarts (18.9 liters) of urine daily.
Your doctor will take a sample of your urine to test for salt and other waste concentrations. This is known as a urine specific gravity test. If you have diabetes insipidus, your urine sample will have a high concentration of water and a low concentration of other waste. Your urine specific gravity results wlll be low.
If your diabetes insipidus is caused by another condition such as a tumor or an issue with the pituitary gland, your doctor will treat that condition first and then determine if the diabetes insipidus still needs to be treated.
The most important action is avoiding dehydration. You can do this by bringing water with you wherever you go or offering water every few hours to your child if they have diabetes insipidus. Your doctor will help you determine how much fluid you should be drinking each day.
Carry a medical alert card in your wallet or wear a medical bracelet so that others know about your diabetes insipidus in case of an emergency. Dehydration can happen quickly, so those around you should know of your condition.
Diabetes insipidus, characterized by excretion of copious volumes of dilute urine, can be life-threatening if not properly diagnosed and managed. It can be caused by two fundamentally different defects: inadequate or impaired secretion of antidiuretic hormone (ADH) from the posterior pituitary gland (neurogenic or central diabetes insipidus) or impaired or insufficient renal response to ADH (nephrogenic diabetes insipidus). The distinction is essential for effective treatment.
Central diabetes insipidus (CDI) is the end result of a number of conditions that affect the hypothalamic-neurohypophyseal system. The known causes include germinoma/craniopharyngioma, Langerhans cell histiocytosis (LCH), local inflammatory, autoimmune or vascular diseases, trauma resulting from surgery or an accident, sarcoidosis, metastases and midline cerebral and cranial malformations. In rare cases, the underlying cause can be genetic defects in vasopressin synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits. The diagnosis of the underlying condition is challenging and raises several concerns for patients and parents as it requires long-term follow-up. Proper etiological diagnosis can be achieved via a series of steps that start with clinical observations and then progress to more sophisticated tools. Specifically, MRI identification of pituitary hyperintensity in the posterior part of the sella, now considered a clear marker of neurohypophyseal functional integrity, together with the careful analysis of pituitary stalk shape and size, have provided the most striking findings contributing to the diagnosis and understanding of some forms of 'idiopathic' CDI. MRI STIR (short-inversion-time inversion recovery sequencing) is a promising technology for the early identification of LCH-dependent CDI.
There are two types of diabetes in dogs. Diabetes mellitus (DM) is also called sugar diabetes and results from a disruption of pancreas function and abnormal regulation of blood sugar. The term, meaning 'sweetened with honey', originated from the fact that the urine of these patients was 'sweet' due to high amounts of sugar excreted from the body.
Diabetes insipidus (DI) gets its name from the fact that the urine of these patients is dilute enough to be 'tasteless' or 'insipid'. Diabetes insipidus (DI) is rare in dogs, and is characterized by excessive thirst/drinking and the production of enormous volumes of extremely dilute urine. Some dogs may produce so much urine that they become incontinent (incapable of controlling their urine outflow). The irony of this disease is that despite drinking large volumes of water, the dog can become dehydrated from urinating so much.
ffe2fad269