Overview
DIABETES INSIPIDUS is a rare medical condition in which there is excessive production of urine and the body becomes unable to retain fluids. It is characterized by feelings of intense thirst (polydipsia) and excessive urination (polyuria). There are various kinds of diabetes insipidus. This article covers several areas about diabetes insipidus.
Key Facts & Statistics
Key facts and statistics that surround DI
- Globally, diabetes insipidus affects about 1 in 25,000 persons.
- It can affect any person. Gestational diabetes insipidus affects expectant mothers, but it is a rare condition.
- It is not related to diabetes types 1 and 2 (diabetes mellitus) but they share some signs and symptoms.
- It is caused by problems with making and utility of anti-diuretic hormone (ADH) or arginine vasopressin (AVP).
Risk Elements
What are the risk factors associated with DI?
- Genetics and family history of DI.
- Medications that cause kidney issues.
- Certain metabolic disorders that cause hypercalcemia or hypokalemia.
- Brain surgery.
- Being pregnant with more than baby.
- Having conditions such as pre-eclampsia and HEELP (Hemolysis, Elevated Liver enzyme levels, and Low Platelet levels) syndrome while pregnant.
Types & Causes
What are the most common types of diabetes insipidus and their causes?
Types of DI
- Gestational diabetes insipidus
- Dipsogenic diabetes insipidus
- Nephrogenic diabetes insipidus
- Central diabetes insipidus
Gestational diabetes insipidus
- It is a rare condition that can develop temporarily when a woman is pregnant.
- In gestational diabetes insipidus, the placenta overproduces an enzyme that breaks down vasopressin.
- It can develop in expectant mothers who bear more than one fetus because of more placental tissue.
- It resolves spontaneously after maternal delivery.
- It is different from gestational diabetes mellitus , a kind of diabetes mellitus that causes higher than normal levels of blood sugar and develops in pregnant women who do not have diabetes mellitus.
Dipsogenic diabetes insipidus
- It is also known as primary polydipsia.
- There is a problem with the hypothalamus which is not related to production of arginine vasopressin.
- It is associated with thirst, excessive intake of fluids and frequent urination.
Nephrogenic diabetes insipidus
- Adequate amounts of ADH are released by the pituitary gland; posterior or ant.
- But the response from by the kidneys is not sufficient enough to help them retain water adequately.
Central diabetes insipidus
- It is the most common type of DI.
- It occurs when there is inadequate ADH in the body.
- ADH is usually produced by the hypothalamus, but storage and release are functions of the posterior pituitary gland.
- Injury or damage to the pituitary gland or the hypothalamus causes central DI.
Causes
Gestational diabetes insipidus
It is caused by overproduction of an enzyme which breaks down AVP. This enzyme is produce by the placenta is expectant women.
Dipsogenic diabetes insipidus
- As stated, it is caused by a problem with the hypothalamus that is not related to ADH production.
- This problem can be caused by:
- Damaged hypothalamus due to surgical procedures, head injuries and infections.
- Mental health disorders such as schizophrenia.
Nephrogenic diabetes insipidus
- Kidneys are unable to utilize ADH maximally.
- This can be due to:
- Medications such as lithium.
- Kidney disease such as polycystic kidney disease (PCKD).
- Electrolyte imbalances such as hypercalcemia and hypokalemia.
- Chronic kidney disease (CKD).
- Inherited genetic mutations of AVPR2 and AQP2 genes.
- Blockage along the urinary tract.
Central diabetes insipidus
- Central diabetes insipidus can be caused by factors such as:
- Inflammation.
- Inherited gene mutation on chromosome 20.
- Surgical procedures, basal skull fractures and tumors which damage and affect the hypothalamus or pituitary gland.
Signs & Symptoms
What are the signs and symptoms of DI?
- Frequent urination.
- Extreme thirst.
- Excessive intake of fluids.
- Urinating clear urine.
Due to dehydration, there may be:
- Fatigue.
- Dizziness.
- Nausea.
- Fainting.
- Dry mouth.
Diagnostic Procedures & Tests
How is DI diagnosed?
- Review of signs and symptoms that the patient presents with.
- Tests. Water deprivation test. It is the most reliable test in DI diagnosis. Under constant supervision, an individual does not take in water for several hours in order to see how they respond. For those with DI, the following can be noticed:
- Urination of excess dilute urine.
- The urine is light-colored.
Other tests diagnose DI or rule out other conditions are:
- Blood tests to check for amount of ADH.
- Glucose level testing to rule out diabetes mellitus.
- Imaging tests to look at integrity of hypothalamus and pituitary gland.
- Urinalysis.
Treatment and Management
Does DI have a cure?
DI cannot be cured. However, it can be managed effectively using medications.
How is DI treated?
- Desmopressin for central DI.
- Thiazide diuretics (sometimes along with non-steroidal anti-inflammatory drugs) for nephrogenic DI.
Hydrochlorothiazide is a diuretic medication often used to treat high blood pressure and swelling due to fluid build, diabetes insipidus, renal tubular acidosis, and to decrease the risk of kidney stones in those with high calcium level in the urine. - Dipsogenic DI does not yet have an effective management strategy. Treatment can be aimed at the underlying medical condition.
Complications
What are the complications of DI?
- Weight loss. Extreme thirst can replace appetite for food. This can lead to slow growth in children and loss of body weigh in adults.
- Dehydration.
- Electrolyte imbalance.
- Disrupted sleep. Waking up regularly at night to pee can be disgusting.