Diabetes insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced can be nearly 20 liters per day. Reduction of fluid has little effect on the concentration of the urine. Complications may include dehydration or seizures.

There are four types of DI, each with a different set of causes.

1. Central DI (CDI), now known as arginine vasopressin deficiency (AVP-D), is due to a lack of vasopressin (antidiuretic hormone) production. This can be due to injury to the hypothalamus or pituitary gland or due to genetics.
2. Nephrogenic DI (NDI), also known as arginine vasopressin resistance (AVP-R), occurs when the kidneys do not respond properly to vasopressin.
3. Dipsogenic DI is a result of excessive fluid intake due to damage to the hypothalamic thirst mechanism. It occurs more often in those with certain psychiatric disorders or on certain medications.
4. Gestational DI occurs only during pregnancy.

Diagnosis is often based on urine tests, blood tests and the fluid deprivation test. Despite the name, diabetes insipidus is unrelated to diabetes mellitus and the conditions have a distinct mechanism, though both can result in the production of large amounts of urine.

Treatment involves drinking sufficient fluids to prevent dehydration. Other treatments depend on the type. In central and gestational DI, treatment is with desmopressin. Nephrogenic DI may be treated by addressing the underlying cause or by the use of a thiazide, aspirin or ibuprofen. The number of new cases of diabetes insipidus each year is 3 in 100,000. Central DI usually starts between the ages of 10 and 20 and occurs in males and females equally. Nephrogenic DI can begin at any age. The term "diabetes" is derived from the Greek word meaning siphon.