diabetes%20insipidus
DIABETES INSIPIDUS
Diabetes insipidus is a polyuric disease characterized by excretion of a large volume of hypotonic urine and hypernatremia. It is due to the absence of antidiuretic hormone.
Central (hypothalamic or neurohypophyseal) diabetes insipidus is the inability to secrete & produce vasopressin in the neurohypophyseal system. It is due to damage to the pituitary gland & hypothalamus, may be due to diseases, head injuries, neurosurgery, infection or genetic or autoimmune disorders.
In nephrogenic diabetes insipidus, there is inappropriate renal response to vasopressin. Kidney function may be impaired by drugs & by chronic disorders like polycystic kidney disease, sickle cell disease, kidney failure, partial ureteral block, hypokalemia, hypocalcemia, low protein diet & genetic disorders.
Primary polydipsia have abnormal increase in fluid intake.

Definition

  • A disease characterized by excretion of a large volume of hypotonic urine that is devoid of taste from dissolved solutes that is caused by the absence of or inadequate response to vasopressin or antidiuretic hormone

Pathophysiologic Mechanisms

Central (Hypothalamic or Neurohypophyseal)

  • Inability to secrete & produce vasopressin in the neurohypophyseal system
  • Damage to the pituitary gland & hypothalamus may be due to diseases, head injuries, neurosurgery, infection or genetic or autoimmune disorders

Nephrogenic

  • There is inappropriate renal response to vasopressin
  • Kidney function may be impaired by drugs & by chronic disorders like polycystic kidney disease, sickle cell disease, kidney failure, partial ureteral block, hypokalemia, hypocalcemia, low protein diet & genetic disorders

Primary Polydipsia

  • Abnormal increase in fluid intake

Other

  • Transient DI of pregnancy due to increased metabolism of vasopressin

Etiology

Central DI

  • Familial
  • Autosomal dominant
  • Cerebral malformations
  • DI, DM & optic atrophy deafness (DIDMOAD) syndrome

Nephrogenic DI

  • Familial
  • Genetic: Autosomal recessive or X-linked recessive inheritance
  • Osmotic diuresis eg DM
  • Metabolic eg hypercalcemia, hypokalemia
  • Trauma, tumor, aneurysm, hemorrhage
  • Idiopathic
  • Granuloma eg TB, sarcoidosis, histiocytosis
  • Infections eg cytomegalovirus (CMV), toxoplasmosis, meningitis

Primary Polydipsia

  • Habitual, compulsive
  • Psychological disturbances
    • Schizophrenia, mania, obsessive-compulsive disorder
  • Drugs eg Lithium, Carbamazepine
    • Hypothalamic lesion
  • May be iatrogenic/healthcare worker-induced (recommendation of a high fluid-intake)
  • Chronic renal disease
  • Drugs eg Lithium, Demeclocycline
  • Post-obstructive uropathy
  • Renal medulla solute washout

Signs and Symptoms

Adults

  • Polyuria
  • Polydipsia
  • Nocturia (3-18 L)
  • Hydronephrosis
  • Bladder enlargement
  • Highly variable urine output
  • Predilection for drinking cold liquids

Infants & Children

  • Poor feeding
  • Failure to thrive
  • Irritability
  • Blunted appetite
  • Nocturia
  • Neonates suck strongly during feeding but may vomit immediately after that
  • Constipation, hard stools
  • Slow growth
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