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 that lead to central DI or NDI. Others may develop after an injury or illness.

Risk Factors

Factors that may increase your risk of DI include:

• Damage to the hypothalamus or pituitary glands due to surgery, infection, stroke, tumor, or head injury
• Certain medications, such as lithium—the most common cause of NDI
• Certain conditions, such as sarcoidosis, tuberculosis, and granulomatosis with polyangiitis
• Kidney disease such as polycystic kidney disease
• Protein malnutrition
• Certain conditions such as hypercalcemia and hypokalemia

Symptoms

Symptoms may include:

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

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

Images may be taken of your bodily structures. This can be done with an MRI scan.

Treatment

Talk with your doctor about the best plan for you. 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—following a low-sodium diet, drinking plenty of water, 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.

Nephrogenic Diabetes Insipidus Foundation http://www.ndif.org

Health Canada http://www.hc-sc.gc.ca

Garofeanu CG, Weir M, Rosas-Arellano MP, et al. Causes of reversible nephrogenic diabetes insipidus: a systematic review. Am J Kidney Dis. 2005;45(4):626-637.

Majzoub JA, Srivatsa A. Diabetes insipidus: clinical and basic aspects. Pediatr Endocrinol Rev. 2006;Suppl 1:60-65.

Nephrogenic diabetes insipidus. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated November 20, 2013. Accessed September 18, 2014.

Rivkees SA, Dunbar N, Wilson TA. The management of central diabetes insipidus in infancy: desmopressin, low renal solue load formula, thazide diuretics. J Pediatr Endocrinol Metab. 2007;20(4):459-469.

Sands JM, Bichet DG. Nephogenic diabetes insipidus. Annals Int Med. 2006;144(3):186-194.

Toumba M, Stanhope R. Morbidity and mortality associated with vasopressin analogue treatment. Pediatr Endocrinol Metab. 2006;19(3):197-201.