DIABETES INSIPIDUS

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Diabetology , Endocrinology

ABOUT THE DISEASE

Diabetes insipidus is a rare condition caused by insufficient antidiuretic hormone (ADH), also known as vasopressin, in the body leading to excessive production of urine because the kidneys are not able to conserve water in the body.

Although some of the symptoms are similar to that of diabetes mellitus which is commonly referred to as just diabetes, diabetes insipidus is not related to the former.

There are four types of diabetes insipidus: central, nephrogenic, gestational and dipsogenic.

SYMPTOMS

• Extreme thirst
• Excreting excessive amount of urine that has little or no color or odor
• Bedwetting
• Nausea
• Fatigue
• Fever
• Dizziness
• Loss of appetite
• Weight loss

CAUSES

Diabetes insipidus is linked to vasopressin, the hormone that promotes water retention in the kidneys.

Central diabetes insipidus is caused when there is a lack of vasopressin in the body. The condition can be primary, i.e., present from birth due to specific genes or secondary which is acquired later in life. The cause of primary central diabetes insipidus is usually unknown while the secondary type is caused due to diseases and injuries that impair vasopressin production in the body.

Nephrogenic diabetes insipidus can be either inherited or acquired. This type affects the response of the kidneys to vasopressin and occurs when there is a defect in the kidney tubules that cause water to be excreted or reabsorbed. While the primary type is caused due to an individual`s genetic makeup, secondary nephrogenic diabetes insipidus can have various causes, such as kidney cysts, chronic hypokalemic nephropathy, kidney infections, some cancers, etc.

Gestational diabetes insipidus is caused when a disturbance of vasopressin takes place due to pregnancy, which in turn, occurs due to the placenta releasing an enzyme that degrades vasopressin.

Dispogenic diabetes insipidus results when there is a problem with an individual`s sense of thirst, leading him or her to be abnormally thirsty and drink a lot of water and then excrete more urine. Prolonged excessive water intake can damage the kidneys and suppress vasopressin, impairing the body`s ability to concentrate urine.

DIAGNOSIS

- Physical examination
- Water deprivation test
- Blood tests
- Vasopressin test
- Imaging tests such as MRI
- Urine concentration and output
- Water deprivation test

TREATMENT METHODS

Treatments for diabetes insipidus aim to reduce the amount of urine produced by the body, but at the same time, the body needs to retain fluid to prevent dehydration. Therefore, drinking plenty of fluids is often recommended to replace the constant loss of water.

Central diabetes insipidus is treated with medications. Vasopressin (Pitressin) or desmopressin (DDAVP) can be taken in spray form to replace the missing vasopressin hormone.

Nephrogenic diabetes insipidus, on the other hand, is usually more difficult to treat and sometimes involves a combination of approaches. If caused by medication, stopping the same may help restore normal kidney function. Medicines such as indomethacin (Indocin), and diuretics like hydrochlorothiazide (Microzide) or amiloride (Moduretic 5-50) can also help relieve the symptoms.

The treatment of gestational diabetes insipidus requires desmopressin.

Some of the same treatments used for other types of diabetes insipidus might also be used for dipsogenic diabetes insipidus. If it is caused by an underlying condition such as mental illness, treatment might be directed at that cause.