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Diabetes insipidus
Diabetes insipidus is an uncommon condition in which the kidneys are unable to prevent the excretion of water.
Causes
During the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. Diabetes insipidus (DI) occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted.
The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland just below the base of the brain.
ADH
Antidiuretic blood test measures the level of antidiuretic hormone (ADH) in blood.
DI caused by a lack of ADH is called central diabetes insipidus . When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus . Nephrogenic means related to the kidney.
Central diabetes insipidus
Central diabetes insipidus is a rare condition that involves extreme thirst and excessive urination.
Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus (NDI) is a disorder in which a defect in the small tubes (tubules) in the kidneys causes a person to pass a large amou...
Central DI can be caused by damage to the hypothalamus or pituitary gland as a result of:
-
Genetic
problems
Genetic
A gene is a short piece of DNA. Genes tell the body how to build specific proteins. There are about 20,000 genes in each cell of the human body. T...
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- Infection
- Loss of blood supply to the pituitary gland
- Surgery
-
Tumors
in or near the pituitary
Tumors
A pituitary tumor is an abnormal growth in the pituitary gland. The pituitary is a small gland at the base of the brain. It regulates the body's ba...
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Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by:
- Certain drugs (such as lithium)
- Genetic problems
-
High level of calcium in the body (
hypercalcemia
)
Hypercalcemia
Hypercalcemia means you have too much calcium in your blood.
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Kidney disease (such as
polycystic kidney disease
)
Polycystic kidney disease
Polycystic kidney disease is a kidney disorder passed down through families. In this disease, many cysts form in the kidneys, causing them to become...
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Symptoms
Symptoms of DI include:
-
Excessive thirst
that may be intense or uncontrollable, usually with the need to drink large amounts of water or craving for ice water
Excessive thirst
Excessive thirst is an abnormal feeling of always needing to drink fluids.
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Excessive urine volume
Excessive urine volume
Excessive amount of urination means that your body makes larger than normal amounts of urine each day.
ImageRead Article Now Book Mark Article - Excessive urination, often needing to urinate every hour throughout the day and night
Exams and Tests
The health care provider will ask about your medical history and symptoms.
Tests that may be ordered include:
-
Blood sodium
and
osmolarity
Blood sodium
The sodium blood test measures the amount of sodium in the blood. Sodium can also be measured using a urine test.
ImageRead Article Now Book Mark ArticleOsmolarity
The osmolality urine test measures the concentration of particles in urine. Osmolality can also be measured using a blood test.
ImageRead Article Now Book Mark Article - Desmopressin (DDAVP) challenge
-
MRI of the head
MRI of the head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
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Urinalysis
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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Urine concentration
and
osmolarity
Urine concentration
A urine concentration test measures the ability of the kidneys to conserve or excrete water.
ImageRead Article Now Book Mark ArticleOsmolarity
The osmolality urine test measures the concentration of particles in urine. Osmolality can also be measured using a blood test.
ImageRead Article Now Book Mark Article - Urine output
Treatment
The cause of the underlying condition will be treated when possible.
Central DI may be controlled with vasopressin (desmopressin, DDAVP). You take vasopressin as an injection, a nasal spray, or tablets.
If nephrogenic DI is caused by medicine, stopping the medicine may help restore normal kidney function. But after many years of use of some medicines, such as lithium, nephrogenic DI can be permanent.
Hereditary nephrogenic DI and lithium-induced nephrogenic DI are treated by drinking enough fluids to match urine output. Medicines that lower urine output also need to be taken.
Nephrogenic DI is treated with anti-inflammatory medicines and diuretics (water pills).
Outlook (Prognosis)
Outcome depends on the underlying disorder. If treated, DI does not cause severe problems or result in early death.
Possible Complications
If your body's thirst control is normal and you are able to drink enough fluids, there are no significant effects on body fluid or salt balance.
Not drinking enough fluids can lead to dehydration and electrolyte imbalance, which can be very dangerous.
Dehydration
Dehydration occurs when your body does not have as much water and fluids as it should. Dehydration can be mild, moderate, or severe, based on how muc...
Electrolyte
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
If DI is treated with vasopressin and your body's thirst control is not normal, drinking more fluids than your body needs can also cause dangerous electrolyte imbalance.
When to Contact a Medical Professional
Call your provider if you develop symptoms of DI.
If you have DI, contact your provider if frequent urination or extreme thirst returns.
References
Bichet DG. Polyuria and diabetes insipidus. In: Alpern RJ, Caplan M, Moe OW, eds. Seldin and Giebisch's The Kidney . 5th ed. Philadelphia, PA: Elsevier; 2013:chap 46.
Carr AC. Diabetes insipidus and other polyuric syndromes. In: Berstein AD, Soni N, eds. Oh's Intensive Care Manual . 7th ed. Philadelphia, PA: Elsevier; 2014:chap 59.
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Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
-
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Review Date: 10/28/2015
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
