WHAT IS DIABETES INSIPIDUS?

Diabetes insipidus is a condition in which the water balance is adversely impacted leading to a loss of water from the body. This can be due to a problem in the brain or kidneys. It is important to note that this is not the same as diabetes mellitus. Diabetes insipidus is much less common than diabetes mellitus and it is not related to blood sugar issues.

What causes diabetes insipidus?

Diabetes insipidus is a condition that involves the nervous system and excretory system. One similarity with the more common diabetes mellitus is that diabetes insipidus can also be due to a hormone problem. 

There are two types of diabetes insipidus, namely central and nephrogenic.

• Central diabetes insipidus is related to a hormone problem.
• Nephrogenic diabetes insipidus is due to a problem with the actual kidney.

A deficiency of which hormone can lead to diabetes insipidus?

Diabetes insipidus can result from a problem with the production or release of the hormone vasopressin. Vasopressin (arginine vasopressin), also known as antidiuretic hormone (ADH) is made by the hypothalamus. After being formed in the hypothalamus the hormone is then transported to and released by the posterior pituitary gland when needed. This hormone acts on the kidney cells to increase the reabsorption of water. This process is disrupted in individuals who have diabetes insipidus.

Some causes of central diabetes insipidus include:

• Genetic mutation: A mutation of the vasopressin gene.

• Tumors in the brain: Examples include craniopharyngiomas and pineal germinomas.
• Sarcoidosis: This is an inflammatory condition.
• Tuberculosis. This can cause insipidus diabetes in some people who also have autoimmune illnesses such as rheumatoid arthritis.
• Brain injury: Traumatic injury where there is injury or a lack of blood supply to the hypothalamus. This can also cause the person to drink too much water because this is the thirst center.
• Brain infection: Encephalitis or meningitis, both inflammatory conditions that impact the brain tissue and membranes.

Is diabetes insipidus a kidney disease?

In some cases, diabetes insipidus is due to a problem with the kidney. This is referred to as nephrogenic diabetes insipidus (NDI). This is often the result of an inherited gene mutation that causes the cells of the kidney to not react properly to the vasopressin. Thus, even though enough hormone is produced the renal tubules don’t respond and water is not reabsorbed and subsequently, urine is not concentrated.

Genetic alteration is one reason NDI occurs. However, there are times when people acquire NDI due to other conditions.

The causes of NDI are listed below:

• Genetic mutations: These can be mutations related to the receptor for vasopressin on the kidney cells or for water channels in the kidney.
• Sickle-cell anemia: An inherited condition in which the hemoglobin in red blood cells is abnormal compromising the blood supply to the kidney.
• Myeloma: A type of cancer that involves one of the types of white blood cells.
• Pyelonephritis: A kidney infection that can develop in someone who has a urinary tract infection that is untreated in which the bacteria spread to the kidneys.
• Medications: Lithium is a medicine that can cause NDI by inflaming the kidney, causing damage.
• Pregnancy: This is normally only a transient condition called gestational diabetes insipidus, which goes away after a baby is born. Enzymes produced by the fetus can temporarily interfere with how the mother’s kidney functions.

Diabetes insipidus symptoms

Some of the symptoms are similar to diabetes mellitus. For example, people feel thirsty and urinate a lot more than normal. The symptoms of diabetes insipidus are all listed below:

• Polydipsia: Increased thirst.
• Polyuria: Excessive urination.
• Dehydration: This is due to the extra loss of water in the urine.
• Hypotonic urine: Urine is very dilute because water is not reabsorbed properly.
• Hypernatremia: Salt levels in the blood are elevated; this can become dangerous and lead to seizures.
• Tiredness: Dehydration due to the illness can make a person have little energy.
• Bedwetting: This is more common in children and can sometimes be due to diabetes insipidus, but is not the only reason for bedwetting in children.
• Dizziness: Dehydration can cause low blood pressure resulting in light-headedness and even fainting.
• Weight loss and delayed growth: This occurs in children who are born having diabetes insipidus.

Diabetes insipidus diagnosis

Diagnosis of diabetes insipidus can be done with the following tests:

• Collecting urine over 24 hours while at the same time limiting how much fluid the person drinks. The urine quantity will be above normal with insipidus diabetes.
• Recording blood electrolytes and noting sodium levels that are above normal.
• Recording osmolality of urine, which should be lower than normal in sick individuals where too much water is being excreted.
• Measuring the concentration of vasopressin in the blood. This will be abnormal if the person has central diabetes insipidus.

Diabetes insipidus treatment

Treatment may vary a bit depending on the type of diabetes insipidus. Hormone analogs that function like vasopressin are only needed where the issue is with vasopressin. In other cases, kidney damage due to drugs may be helped by NSAIDs.

Treatment of diabetes insipidus involves the following:

• Desmopressin: This is a medication that acts like vasopressin and is given to patients who have problems producing enough of the hormone. It can be taken orally or be given intravenously.
• Thiazide diuretics: Increases the uptake of sodium in parts of the kidney leading to better reabsorption of water further along the kidney tubules.
• NSAIDs: Non-steroidal anti-inflammatories work best where the kidney is damaged by medication (e.g., lithium-induced damage). It helps stop the production of prostaglandins and has an anti-diuretic effect.
• Diet changes:  A low protein and reduced salt diet is recommended for those who have NDI, specifically where the kidney is damaged.

Conclusion

Diabetes insipidus is an uncommon illness in which too much water is excreted and lost. The causes of this problem are multiple. The condition can be due to genetic mutation but can also be caused by medication or other diseases or injuries. Treatment varies depending on the cause and may include a combination of medication and diet changes.

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Sources

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