Diabetes Insipidus
Basics
Description
Description
- Disorder in which large volumes of dilute urine are excreted (polyuria) as an inappropriate response to antidiuretic hormone, arginine vasopressin (AVP)
- Polyuria defined as >3 L in 24 hr
- Often characterized by excessive fluid intake (polydipsia)
- 2 types:
- Central diabetes insipidus (DI, CDI; failure or deficiency of AVP release):
- 4 types:
- No AVP to release (loss or malfunction of posterior pituitary neurons)
- Defective osmoreceptors – release AVP only in response to severe dehydration
- Elevated threshold for AVP release
- Subnormal amount of AVP released
- Familial cases have been reported (autosomal dominant)
- 4 types:
- Nephrogenic DI (lack of renal response to AVP):
- Differentiate from primary polydipsia
- Some cases are X-linked recessive in males
- Central diabetes insipidus (DI, CDI; failure or deficiency of AVP release):
- Must be distinguished from primary polydipsia caused by either psychiatric disorder or abnormal thirst
Etiology
Etiology
- Central DI:
- Any condition that disrupts the osmoreceptor–hypothalamus–hypophyseal axis:
- Highest incident in ages 10–20 yr:
- Trauma (skull fractures, hemorrhage)
- Pituitary or hypothalamic surgery
- CNS neoplasm: DI can be considered a tumor marker:
- Pituitary adenomas
- Craniopharyngiomas
- Germinomas
- Pinealomas
- Meningiomas
- Metastatic tumors:
- Leukemia/lymphoma
- Granulomatous:
- Histiocytosis
- Sarcoidosis
- Congenital CNS defects
- CNS infections (e.g., meningitis, encephalitis)
- Pregnancy (Sheehan syndrome)
- Idiopathic (autoantibodies, occult tumor)
- Wolfram syndrome (DI, DM, optic atrophy, deafness)
- Ethanol
- Nephrogenic DI:
- Any condition that impairs the kidney's response to AVP:
- Congenital renal disorders
- Obstructive uropathy
- Renal dysplasia
- Polycystic kidney disease
- Systemic disease with renal involvement
- Sickle cell disease
- Sarcoidosis
- Amyloidosis
- Drugs:
- Lithium (most common and persists past discontinuation of drug)
- Amphotericin
- Phenytoin
- Aminoglycosides
- Methoxyflurane
- Demeclocycline
- Electrolyte disorders:
- Hypercalcemia
- Hypokalemia
- Any condition that impairs the kidney's response to AVP:
Pregnancy Considerations
- Typically presents in the second trimester:
- Unclear etiology, but likely increased production of vasopressinase by the placenta
- Leads to a decrease in AVP and transient DI
- Watch patient closely during anesthesia and periods of water restriction
- Typically clears after 2–6 wk after delivery
- Can treat with desmopressin (DDAVP), which resists this additional vasopressinase
- Sheehan syndrome may cause DI
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Citation
Schaider, Jeffrey J., et al., editors. "Diabetes Insipidus." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307104/all/Diabetes_Insipidus.
Diabetes Insipidus. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307104/all/Diabetes_Insipidus. Accessed December 7, 2024.
Diabetes Insipidus. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307104/all/Diabetes_Insipidus
Diabetes Insipidus [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307104/all/Diabetes_Insipidus.
* Article titles in AMA citation format should be in sentence-case
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