What is diabetes insipidus?

The rare condition of diabetes insipidus needs a complete workup for diagnosis, and management by Best Internal Medicine Specialist in Karachi. Diabetes insipidus is not related to diabetes mellitus, but presents similarly with intense third and increased urination.

Read on to know more about disease symptomology, diagnosis and treatment of diabetes insipidus:

What is diabetes insipidus?

 

Diabetes insipidus is a rare disorder that leads to fluid imbalance in the body due to increased urination and intense thirst. In fact, a person can urinate even 20 liters of urine in a day if he keeps drinking fluids. A healthy adult, typically urinates about 1 to 2 liters a day.

What are the causes of diabetes insipidus?

 

Diabetes insipidus presents with: extreme thirst, production of large amount of pale urine, urinating during the night and dehydration if the fluid needs are not met.

 

The cause behind diabetes insipidus is the block in the production or the effect of antidiuretic hormone (ADH). Anti-diuretic hormone is made in the brain, by a region called hypothalamus and stored in the pituitary. In diabetes insipidus, the production of ADH is impacted, or the kidneys don’t respond to this hormone, resulting in water and salt wasting.

What are the types of diabetes insipidus?

 

Central diabetes insipidus: this occurs when the hypothalamus fails to produce adequate amounts of ADH, or the pituitary fails to store it. This may be seen in traumas, secondary to surgery, tumor or head injury that damages the gland. Sometimes, it may be due to an inherited defect.

 

Nephrogenic diabetes insipidus: even though the production of ADH by the hypothalamus is adequate in this type of diabetes insipidus, the kidneys don’t respond to ADH. This is due to either a structural defect in the kidneys, due to an inherited disorder or chronic kidney disease. In addition, certain drugs like lithium or antiviral medication can result in kidney damage leading to nephrogenic diabetes insipidus.

 

Primary polydipsia: is also called dipsogenic diabetes insipidus, which causes production of a large amount of dilute urine due to drinking excessively. The pathology behind this illness is the defect in thirst-regulating mechanism or schizophrenia.

 

Autoimmune disorders: can lead to diabetes insipidus due to damage of the ADH producing cells when the body’s immune system fights these cells, mistakenly.

 

Gestational diabetes insipidus: this type of diabetes insipidus occurs during pregnancy, alone. This is a rare disorder that presents due to damage to the ADH in the mother due to a placental enzyme.  

How is diabetes insipidus diagnosed?

 

The diagnosis of diabetes insipidus is based on the history presented by the patient, and some investigations like:

 

Water deprivation test:

This test forms the basis of diabetes insipidus diagnosis. In this test, the patient is asked to stop the intake of fluids for several hours. During this time of fluid restriction, the body should naturally produce ADH and produce less urine. The healthcare provider checks the level of serum ADH, and also measures the serum and urine osmolarity. The tests are repeated when synthetic analogue of ADH is given. This helps to diagnose the deficiency of ADH and the type of diabetes insipidus.

 

MRI:

An MRI looks for abnormalities in the brain and hypothalamus that could lead to decreased production of ADH.

What are the treatment options for diabetes insipidus?

For central and gestational diabetes insipidus, the treatment is centered around fluid intake and synthetic analogue of ADH called desmopressin, which supplements the missing hormone.

For nephrogenic diabetes, diuretics like hydrochlorothiazide improve symptoms.

There is no cure for diabetes insipidus, but a healthcare professional like Internal Medicine specialist in Lahore can help keep the symptoms under control and prevent dehydration.