Diabetes Insipidus

Definition

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

There are 2 forms of 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 caused by genetic problems. Most others develop after an injury, illness, or exposure to a medication.

Pituitary Gland

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Risk Factors

Factors that may increase your risk of DI include:

• Central diabetes insipidus (central DI)
  • Damage to the hypothalamus or pituitary glands due to surgery, infection, stroke, brain tumor, or head injury
  • Certain conditions that can infiltrate the brain, such as sarcoidosis, tuberculosis, lymphocytic hypophysitis, and granulomatosis with polyangiitis
  • Most idiopathic or congenital causes result in central DI
• Nephrogenic diabetes insipidus (NDI)
  • Certain medications, such as lithium—the most common cause of NDI
  • Kidney disease such as polycystic kidney disease
  • Kidney infection or blockage
  • Protein malnutrition
  • Certain conditions such as hypercalcemia, hypokalemia, sarcoidosis, amyloidosis, and sickle cell disease

Symptoms

Symptoms may include:

• Increased urination, especially during the night
• Extreme thirst
• Nighttime urination
• Dehydration—fast heart rate, dry skin and mouth, fatigue, dizziness, confusion

Diagnosis

You will be asked about your symptoms and medical history. A physical exam may be done.

Your bodily fluids may be tested. This can be done with:

• Blood tests
• Urine tests
• Water deprivation test
• Desmopressin challenge test

Images may be taken of your bodily structures, usually the urinary tract or brain. This can be done with ultrasound or an MRI scan.

Treatment

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
  • Drinking plenty of water
  • Treating any underlying cause
  • Following a low-sodium diet
  • Taking a diuretic

Prevention

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