From the Guidelines
Diabetes insipidus is primarily caused by problems with the production or action of antidiuretic hormone (ADH), also called vasopressin, which can be due to various factors including genetic disorders, damage to the brain's hypothalamus or pituitary gland, chronic kidney disease, or certain medications. The causes of diabetes insipidus can be broadly categorized into central diabetes insipidus, nephrogenic diabetes insipidus, gestational diabetes insipidus, and primary polydipsia.
- Central diabetes insipidus occurs when the brain's hypothalamus or pituitary gland doesn't produce or release enough ADH, typically due to damage from surgery, head trauma, tumors, or genetic disorders.
- Nephrogenic diabetes insipidus happens when the kidneys don't respond properly to normal ADH levels, often resulting from chronic kidney disease, certain medications (like lithium), genetic mutations, or electrolyte disorders, as noted in a recent expert consensus statement on the diagnosis and management of congenital nephrogenic diabetes insipidus 1.
- Gestational diabetes insipidus can develop during pregnancy when an enzyme produced by the placenta destroys ADH.
- Primary polydipsia, sometimes called dipsogenic diabetes insipidus, is caused by excessive fluid intake that suppresses ADH production. All these conditions lead to the same primary symptoms: excessive urination (polyuria) and extreme thirst (polydipsia), as the body cannot properly concentrate urine and conserve water. Treatment depends on identifying the specific cause and may include desmopressin (DDAVP) for central diabetes insipidus, addressing underlying conditions or changing medications for nephrogenic diabetes insipidus, and fluid restriction for primary polydipsia, with the goal of managing symptoms and preventing complications such as hypertonic dehydration, as emphasized in recent guidelines 1.
From the FDA Drug Label
Diabetes Insipidus: Desmopressin acetate injection 4 mcg/mL is indicated as antidiuretic replacement therapy in the management of central (cranial) diabetes insipidus and for the management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region. The causes of diabetes insipidus are not explicitly stated in the label, but it can be inferred that central (cranial) diabetes insipidus may be caused by:
- Head trauma
- Surgery in the pituitary region 2
From the Research
Causes of Diabetes Insipidus
The causes of diabetes insipidus can be categorized into several types, including:
- Central diabetes insipidus, which is caused by a deficiency in the production of antidiuretic hormone (ADH) arginine vasopressin 3, 4, 5, 6
- Nephrogenic diabetes insipidus, which is caused by an impaired response of the kidneys to ADH 3, 4, 7, 5, 6
- Primary polydipsia, which is caused by excessive fluid intake 3, 5
- Gestational diabetes insipidus, which is caused by increased metabolism of ADH during pregnancy 3, 4
- Dipsogenic diabetes insipidus, which is caused by excessive thirst due to a low osmotic threshold 4, 5
Acquired Causes
Acquired causes of nephrogenic diabetes insipidus include:
- Lithium-induced nephrogenic diabetes insipidus, which is a common cause of acquired nephrogenic diabetes insipidus 7
- Other medications and medical conditions that affect the kidneys' ability to respond to ADH
Genetic Causes
Genetic causes of diabetes insipidus must be evaluated, especially if symptoms occur in early childhood 5