Diabetes insipidus is characterized by excessive urine production associated with intense thirst. It is possible to distinguish several types, the most common of which are neurogenic diabetes insipidus and nephrogenic diabetes insipidus.
The latter do not have exactly the same characteristics but both reflect a regulatory problem in the kidneys. The body does not retain enough water to cover its needs.
What is diabetes insipidus?
Definition of diabetes insipidus
Diabetes insipidus is the consequence of a deficiency or insensitivity to the antidiuretic hormone: vasopressin. As part of normal body functioning, this hormone is produced in the hypothalamus and then stored in the pituitary gland.
After these two stages within the brain, vasopressin is released within the body to regulate the amounts of water in the body. It will act on the kidneys to reabsorb filtered water, and thus prevent its elimination in the urine. In this way, it helps to cover the body’s water needs.
In diabetes insipidus, vasopressin cannot play its role as an antidiuretic agent. Water is eliminated in excessive amounts, resulting in excessive urine production associated with intense thirst.
Types of diabetes tasteless
The mechanisms involved in diabetes insipidus are not always the same. This is why it is possible to distinguish several forms:
- neurogenic or central diabetes insipidus, which is caused by the insufficient release of antidiuretic hormone in the hypothalamus;
- nephrogenic or peripheral diabetes insipidus, which is caused by the insensitivity of the kidney to antidiuretic hormones;
- gestational diabetes insipidus, a rare form occurring during pregnancy that is most often the consequence of a breakdown of vasopressin in the blood;
- Dipsogenic diabetes insipidus is characterized by a disorder of the thirst mechanism in the hypothalamus.
Causes of diabetes insipidus
At this stage, it should be noted that diabetes insipidus can be congenital (present from birth), acquired (consecutive to external parameters), or idiopathic (with an unknown cause).
Causes identified to date include:
- head trauma or brain damage;
- brain surgeries;
- vascular lesions such as aneurysms (localized dilation of the wall of an artery) and thrombosis (formation of a blood clot);
- certain forms of cancer, including brain tumors;
- autoimmune diseases;
- nervous system infections such as encephalitis and meningitis ;
- tuberculosis ;
- sarcoidosis ;
- polycystic kidney disease (cysts in the kidneys);
- sickle cell disease ;
- medullary terry kidney (congenital kidney disease);
- severe pyelonephritis;
- amyloidosis ;
- Sjögren’s syndrome ;
Diagnosis of diabetes insipidus
Diabetes insipidus is suspected as soon as large amounts of urine are excreted associated with extreme thirst. Confirmation of the diagnosis can then be based on:
- a fluid restriction test that measures urine production, blood electrolyte concentration, and weight at regular intervals;
- urinalysis to check for sugar in the urine (characteristic of diabetes mellitus);
- blood tests to identify a high sodium concentration.
Depending on the case, other additional tests may then be considered to identify the cause of diabetes insipidus.
Many cases of diabetes insipidus are of hereditary origin. A family history of diabetes insipidus is an important risk factor.
Symptoms of diabetes insipidus
- Polyuria: One of the typical symptoms of diabetes insipidus is polyuria. This is an excessive production of urine exceeding 3 liters per day and can reach up to 30 liters in the most severe cases.
- Polydipsia: The second characteristic symptom is polydipsia. This is the perception of an intense thirst between 3 and 30 liters per day.
- Possible nocturia: It is common for polyuria and polydipsia to be accompanied by nocturia, a need to urinate at night.
- Dehydration: In the absence of appropriate management, diabetes insipidus can induce dehydration and functional impairment of the body. Hypotension and shock may be noted.
Treatments for diabetes insipidus
Management depends on many parameters, including the type of diabetes insipidus. It may include, but is not limited to:
- adequate hydration;
- restriction of dietary salt and protein intake;
- administration of vasopressin or similar forms such as desmopressin;
- the administration of molecules stimulating the production of vasopressin such as thiazide diuretics, chlorpropamide, carbamazepine, or clofibrate;
- a specific treatment targeting the identified cause.
Preventing diabetes insipidus
To date, no prevention solution has been established. In many cases, diabetes insipidus is of hereditary origin.
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