Diabetes insipidus - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Diabetes insipidus (DI) is a disorder characterized by polydipsia, polyuria, and formation of inappropriately hypotonic (dilute) urine.
Two types exist: central DI, due to reduced synthesis or release of arginine vasopressin (AVP) from the hypothalamo-pituitary axis; and nephrogenic DI, due to renal insensitivity to AVP.
Recognized risk factors for central DI include pituitary surgery, craniopharyngioma, infiltrative pituitary stalk lesions, traumatic brain injury, subarachnoid hemorrhage, congenital hypothalamo-pituitary defects, autoimmune disorders, and Wolfram syndrome. Risk factors for nephrogenic DI include lithium therapy, chronic kidney disease, and chronic hypercalcemia or hypokalemia. Genetic mutations are responsible for inherited forms of both types.
Both types of DI may be associated with hypernatremia, and this may present as a medical emergency.
Treatment goals are correction and stabilization of water deficit and electrolyte balance, together with reduction in symptoms of excessive urinary water loss and thirst. In central DI, the synthetic AVP analog desmopressin (DDAVP) is the treatment of choice. Nephrogenic DI is treated with an adequate fluid intake; salt restriction and diuretics may help reduce polyuria.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Vasopressin: gene structure and post-translational processing
Physiology of AVP and thirst

Citations

Key Articles

Robinson A, Verbalis J. Posterior pituitary. In: Melmed S, Polonsky K, Larsen PR, et al, eds. Williams textbook of endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:300-32.
Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clin Endocrinol (Oxf). 2019 Jan;90(1):23-30.[Abstract][Full Text]
Kavanagh C, Uy NS. Nephrogenic diabetes insipidus. Pediatr Clin North Am. 2019 Feb;66(1):227-34.[Abstract]
Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol. 2015 Oct;11(10):576-88.[Abstract]
Knepper MA, Kwon TH, Nielsen S. Molecular physiology of water balance. N Engl J Med. 2015 Apr 2;372(14):1349-58.[Abstract]

Other Online Resources

NDI Foundation (DIF)
NIDDK: diabetes insipidus
Pituitary Foundation (UK): diabetes insipidus

Referenced Articles

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