Healthcare Library

Spanish Version
Print-Friendly
Bookmarks
bookmarks-menu

Diabetes insipidus

Diabetes insipidus (DI) is an uncommon condition in which the kidneys are unable to prevent the excretion of water.

DI is not the same as diabetes mellitus types 1 and 2. However, untreated, both DI and diabetes mellitus cause constant thirst and frequent urination. People with diabetes mellitus have high blood sugar (glucose) because the body is not able to use blood sugar for energy. Those with DI have normal blood sugar levels, but their kidneys are not able to balance fluid in the body.

Causes

During the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. DI occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted.

The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland just below the base of the brain.

DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. Nephrogenic means related to the kidney.

Central DI can be caused by damage to the hypothalamus or pituitary gland as a result of:

  • Genetic problems
  • Head injury
  • Infection
  • Problem with the ADH-producing cells due to an autoimmune disease
  • Loss of blood supply to the pituitary gland
  • Surgery in the area of the pituitary gland or hypothalamus
  • Tumors in or near the pituitary gland

Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by:

Symptoms

Symptoms of DI include:

  • Excessive thirst that may be intense or uncontrollable, usually with the need to drink large amounts of water or craving for ice water
  • Excessive urine volume
  • Excessive urination, often needing to urinate every hour throughout the day and night
  • Very dilute, pale urine

Exams and Tests

The health care provider will ask about your medical history and symptoms.

Tests that may be ordered include:

Your provider may have you see a doctor who specializes in pituitary diseases to help diagnose DI.

Treatment

The cause of the underlying condition will be treated when possible.

Central DI may be controlled with vasopressin (desmopressin, DDAVP). You take vasopressin as an injection, a nasal spray, or tablets.

If nephrogenic DI is caused by medicine, stopping the medicine may help restore normal kidney function. But after many years of use of some medicines, such as lithium, nephrogenic DI can be permanent.

Hereditary nephrogenic DI and lithium-induced nephrogenic DI are treated by drinking enough fluids to match urine output. Medicines that lower urine output also need to be taken.

Nephrogenic DI is treated with anti-inflammatory medicines and diuretics (water pills).

Outlook (Prognosis)

Outcome depends on the underlying disorder. If treated, DI does not cause severe problems or result in early death.

Possible Complications

If your body's thirst control is normal and you are able to drink enough fluids, there are no significant effects on body fluid or salt balance.

Not drinking enough fluids can lead to dehydration and electrolyte imbalance, which can be very dangerous.

If DI is treated with vasopressin and your body's thirst control is not normal, drinking more fluids than your body needs can also cause dangerous electrolyte imbalance.

When to Contact a Medical Professional

Call your provider if you develop symptoms of DI.

If you have DI, contact your provider if frequent urination or extreme thirst returns.

References

Hannon MJ, Thompson CJ. Vasopressin, diabetes insipidus, and the syndrome of inappropriate antidiuresis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 18.

Verbalis JG. Disorders of water balance. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 16.

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Osmolality test

      Osmolality test - illustration

      An osmolality urine test is performed to measure the concentration of particles in urine. Greater than normal results may indicate conditions such as Addison disease, congestive heart failure or shock. Lower-than-normal measurements may indicate aldosteronism, diabetes insipidus, excess fluid intake, renal tubular necrosis or severe pyelonephritis.

      Osmolality test

      illustration

      • Endocrine glands

        Endocrine glands - illustration

        Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

        Endocrine glands

        illustration

      • Osmolality test

        Osmolality test - illustration

        An osmolality urine test is performed to measure the concentration of particles in urine. Greater than normal results may indicate conditions such as Addison disease, congestive heart failure or shock. Lower-than-normal measurements may indicate aldosteronism, diabetes insipidus, excess fluid intake, renal tubular necrosis or severe pyelonephritis.

        Osmolality test

        illustration

      Review Date: 5/6/2019

      Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
      adam.com

       
       
       

       

       

      A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.
      Content is best viewed in IE9 or above, Firefox and Google Chrome browser.

      ways to give

      view all

      news room

      view all

      healthcare library

      view all
      Event Calendar

      Hunterdon Healthcare offers an array of educational events, including childbirth, healthy living and fitness classes.

      LEARN MORE
      Health and Wellness Centers

      Where health and fitness meet to help you stay healthy at every age.

      LEARN MORE
      Heart & Vascular

      Heart and Vascular Services Department brings world-class cardiovascular care to our community.

      LEARN MORE