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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Oct 2015
Type 1 diabetes mellitus occurrence among the paediatric population is fast rising, especially among 5-9-year olds, based on a 26-year observational study.
Pearl Toh, 20 Jul 2018
Women with pre-eclampsia or gestational hypertension during their first pregnancy had an increased risk of developing chronic hypertension, type 2 diabetes (T2D), and hypercholesterolaemia than those who were normotensive during pregnancy, according to a study. The risk persisted for several decades later, signalling these hypertensive disorders of pregnancy (HDP) as red flags for cardiovascular (CV) health for life.
Roshini Claire Anthony, 30 Jul 2018

Canagliflozin may provide a renoprotective effect in individuals with type 2 diabetes (T2D) and a history of cardiovascular disease (CVD), according to results from the CANVAS* Program.

Stephen Padilla, 31 Jul 2018
Patients with type 2 diabetes (T2D) treated with sulphonylureas as second-line drugs are at an increased risk of myocardial infarction (MI), all-cause mortality and severe hypoglycaemia compared with those who remained on metformin monotherapy, a recent study has found.