What is diabetes insipidus?

Diabetes insipidus results from decreased secretion or resistance to the action of the antidiuretic hormone, leading to inability to concentrate urine and thus excretion of a large amount (polyuria) of dilute, without taste (insipidus) urine.


What is the prevalence of diabetes insipidus?

The prevalence of the disease is 3 cases per 100,000 population.


What is the etiology of diabetes insipidus?

Depending on the cause, diabetes insipidus is divided into central and nephrogenic.

The causes of central diabetes insipidus are:

  • idiopathic
  • lesions in the hypothalamic-pituitary area, such as tumors, autoimmune, inflammatory or granulomatous diseases, hypoxia/brain ischemia
  • trauma, neurosurgery, brain radiation
  • congenital anomalies, such as midline abnormalities, congenital hypopituitarism, and genetic mutations leading either to its familial form or to Wolfram syndrome.

The causes of nephrogenic diabetes insipidus, on the other hand, are characterized by electrolyte abnormalities, such as:

  • chronic hypercalcaemia
  • kidney disease
  • medications, such as lithium
  • multiple myeloma
  • sickle cell anemia
  • pregnancy
  • mutations that lead to its inherited form

What are the symptoms and signs of diabetes insipidus?

The symptoms of the disease include polyuria, nocturia, polydipsia and neurological symptoms:

  • intense thirst (polydipsia)
  • passage of large volume of dilute urine (polyuria), nocturia
  • tiredness
  • weakness
  • nausea, vomiting
  • dizziness, confusion

What are the complications of diabetes insipidus?

Polyuria leads to dehydration, which in turn mobilizes, through the feeling of thirst, fluid intake. In diabetes insipidus however, the inability to concentrate urine will lead again to polyuria and thus polydipsia, leading to a vicious cycle:

  • Dehydration will eventually lead to
  • Growth retardation and linear growth defects
  • Electrolyte abnormalities, which may be
  • Life-threatening

How is the diagnosis of diabetes insipidus made?

Diagnosis of the disease requires exclusion of other causes of polyuria, measurement of osmolality and electrolytes in the blood and urine, water deprivation test (always in a controlled environment), imaging and in some cases genetic testing.


What is the treatment of diabetes insipidus?

The treatment of choice of central diabetes insipidus:

  • is hormone replacement therapy with vasopressin,
  • as well as the treatment of the underlying cause.

Treatment of nephrogenic diabetes insipidus includes:

  • removal of the underlying cause,
  • thiazide diuretics and
  • low-sodium, low-protein diet.

Regular monitoring and follow-up visits are important to prevent dehydration, electrolyte abnormalities and related complications.