From the Guidelines
Diabetes insipidus is primarily caused by either insufficient production of antidiuretic hormone (ADH) by the hypothalamus or kidney resistance to ADH action, as highlighted in the most recent expert consensus statement 1. The etiology of diabetes insipidus can be broadly categorized into central diabetes insipidus, which results from inadequate ADH production, and nephrogenic diabetes insipidus, which occurs when the kidneys cannot respond properly to ADH. Central diabetes insipidus can be caused by various factors including brain tumors, head trauma, neurosurgery, autoimmune disorders, genetic mutations, or infiltrative diseases like sarcoidosis. On the other hand, nephrogenic diabetes insipidus may be due to genetic mutations in the vasopressin receptor, chronic kidney disease, electrolyte disorders (especially hypercalcemia and hypokalemia), certain medications (lithium, demeclocycline, amphotericin B), or pregnancy (gestational diabetes insipidus) 1.
Key factors to consider in the diagnosis and management of diabetes insipidus include:
- Genetic testing to identify the underlying cause, particularly in cases of congenital nephrogenic diabetes insipidus 1
- Differential diagnosis to distinguish between central and nephrogenic diabetes insipidus, as well as other conditions that may present with similar symptoms, such as primary polydipsia, poorly controlled diabetes mellitus, and secondary forms of inherited nephrogenic diabetes insipidus 1
- Treatment approaches, including the use of thiazides and prostaglandin synthesis inhibitors, as well as dietary counseling to minimize renal osmotic load and reduce urine volume 1
The most effective approach to managing diabetes insipidus involves a multidisciplinary team that includes a nephrologist, dietitian, psychologist, social worker, and urologist, as recommended by the recent expert consensus statement 1.
From the Research
Etiology of Diabetes Insipidus
The etiology of diabetes insipidus can be attributed to several factors, including:
- Impaired secretion of antidiuretic hormone (ADH) from the posterior pituitary gland, resulting in central or neurogenic diabetes insipidus 2, 3, 4, 5
- Impaired renal response to ADH, leading to nephrogenic diabetes insipidus 2, 3, 4, 5
- Excessive fluid intake, resulting in primary polydipsia 3, 5
- Increased metabolism of the hormone, as seen in gestational diabetes insipidus 3, 4
- Genetic causes, which can lead to central or nephrogenic diabetes insipidus, especially if symptoms occur in early childhood 5
- Lithium-induced nephrogenic diabetes insipidus, which is a common cause of acquired nephrogenic diabetes insipidus 6
Classification of Diabetes Insipidus
Diabetes insipidus can be classified into four main types:
- Central diabetes insipidus (CDI), characterized by a deficiency of ADH secretion from the posterior pituitary gland 4, 5
- Nephrogenic diabetes insipidus (NDI), characterized by impaired renal response to ADH 4, 5
- Dipsogenic diabetes insipidus, characterized by excessive thirst due to a low osmotic threshold 4
- Gestational diabetes insipidus, characterized by increased concentration of placental vasopressinase during pregnancy 4