What is the prevalence of diabetes insipidus and can it occur in adults over 60?

Is Diabetes Insipidus Rare and Can a 61-Year-Old Develop It?

Yes, diabetes insipidus (DI) is rare with a prevalence of approximately 1 in 25,000 people, and a 61-year-old can absolutely develop it—age is not a barrier to acquiring this condition. 1, 2

Rarity of Diabetes Insipidus

• DI is definitively a rare disorder, affecting approximately 1 in 25,000 individuals in the general population 1, 2
• The exact incidence and prevalence of congenital nephrogenic DI specifically are unknown, but it is considered even rarer than acquired forms 3
• Secondary (acquired) forms of DI are more frequent than congenital forms and can develop at any age 3

Age Distribution and Onset Patterns

Congenital Forms

• Congenital nephrogenic DI typically presents early in life, with a mean age at diagnosis of approximately 4 months, manifesting with polyuria, failure to thrive, and dehydration 3

Acquired Forms (Most Relevant for Adults)

• Acquired central DI can develop at any age throughout the lifespan, including in older adults like a 61-year-old 4
• In a large pediatric and young adult cohort, the median age at diagnosis was 7.0 years, but the range extended up to 24.8 years, demonstrating that DI commonly presents beyond childhood 4
• There is no upper age limit for developing DI—the condition can manifest in older adults when triggered by various acquired causes 1, 2

Why a 61-Year-Old Can Develop DI

Common Acquired Causes in Adults

• Intracranial tumors (pituitary adenomas, craniopharyngiomas, metastases) can cause central DI at any age 4
• Head trauma or neurosurgery in the pituitary region can trigger DI, regardless of when the injury occurs 5, 4
• Langerhans cell histiocytosis can present in adults and cause DI 3, 4
• Autoimmune conditions may develop later in life 4
• Medications (particularly lithium) can cause nephrogenic DI in adults of any age 6
• Idiopathic cases account for approximately 50% of central DI cases and can present at any age 3, 4

Age-Related Considerations

• Older adults may actually be at higher risk for complications from DI, particularly hyponatremia when treated with desmopressin, requiring more frequent monitoring 5
• The FDA label specifically notes that patients 65 years and older require more frequent serum sodium monitoring during DI treatment 5

Clinical Presentation in Adults

• In older children and adults, polydipsia (excessive thirst) is the predominant symptom at diagnosis, rather than the dehydration seen in infants 3
• Adults typically present with hypotonic polyuria (large volumes of dilute urine) and compensatory increased fluid intake 1, 2
• Serum osmolality is usually >300 mOsm/kg H₂O due to hypernatremia, while urine osmolality is inappropriately low at <200 mOsm/kg H₂O 3

Important Diagnostic Considerations

• The diagnosis of DI is frequently delayed because many practitioners are unfamiliar with this rare condition 3
• The gold standard for diagnosis remains the water deprivation test followed by desmopressin administration, though copeptin measurement is emerging as a simpler alternative 1, 2
• MRI findings are abnormal in 94% of cases, showing absence of posterior pituitary hyperintensity, and may reveal pituitary stalk thickening in 37% of patients 4

Key Clinical Pitfalls

• Do not assume DI only occurs in children—this misconception can lead to delayed diagnosis in adults 3, 4
• Approximately 61% of patients with central DI develop anterior pituitary hormone deficiencies during follow-up, requiring comprehensive endocrine evaluation 4
• In adults over 60, careful attention must be paid to fluid balance and sodium monitoring, as this age group is at increased risk for treatment-related hyponatremia 5