Diabetes insipidus
Diabetes insipidus is a rare, chronic endocrine condition characterized by excessive thirst (polydipsia) and excessive urination (polyuria), specifically the excretion of abnormally large volumes of dilute urine. This condition is not related to diabetes mellitus, a disorder of insulin deficiency or resistance, despite sharing the common name diabetes, derived from the Greek word for siphon.[1]
Classification[edit | edit source]
Diabetes insipidus can be categorized into four types:[2] Central Diabetes Insipidus: Arises from a deficiency of vasopressin, also known as antidiuretic hormone (ADH), caused by damage to the hypothalamus or pituitary gland. Nephrogenic Diabetes Insipidus: Occurs when the kidneys are unable to respond to vasopressin. Gestational Diabetes Insipidus: Occurs only during pregnancy and the postpartum period. In some cases, an enzyme made by the placenta—vasopressinase—destroys the mother's vasopressin. Dipsogenic Diabetes insipidus: Results from a defect in thirst sensation, leading to chronic fluid intake that suppresses vasopressin secretion.
Symptoms and Signs[edit | edit source]
The primary symptoms of diabetes insipidus are excessive thirst and the production of large volumes of dilute urine. These symptoms may lead to dehydration, dry skin, rapid heart rate (tachycardia), low blood pressure (hypotension), and fatigue. Without treatment, severe dehydration and electrolyte imbalance can develop, which are serious medical conditions.[3]
Diagnosis[edit | edit source]
Diagnosis typically involves clinical evaluation, urine and blood tests, a water deprivation test, and sometimes a magnetic resonance imaging (MRI) scan to identify potential damage to the hypothalamus or pituitary gland.[4]
Treatment[edit | edit source]
Treatment involves addressing the underlying cause, if possible, and replacing the deficient hormone. Synthetic vasopressin, or desmopressin, can be taken as a nasal spray, oral tablet, or injection to replace the missing vasopressin in central diabetes insipidus. For nephrogenic diabetes insipidus, treatment may involve a low-salt diet to reduce the amount of urine the kidneys make, and certain diuretics to help the kidneys reduce fluid accumulation.[5] Adequate hydration is crucial in all forms of diabetes insipidus.
Prognosis[edit | edit source]
The prognosis for patients with diabetes insipidus largely depends on the underlying cause. If the condition is managed appropriately, individuals can lead normal lives. However, if left untreated, diabetes insipidus can cause severe dehydration and other complications.[6]
Epidemiology[edit | edit source]
Diabetes insipidus is a rare condition. Its incidence is estimated to be 1 in 25,000 individuals. It affects males and females equally, and can occur at any age.[7]
See also[edit | edit source]
References[edit | edit source]
- ↑ Robertson, G L, Diabetes insipidus: Differential diagnosis and management, Best Practice & Research Clinical Endocrinology & Metabolism, 2016, Vol. 30(Issue: 2), pp. 205–218, DOI: 10.1016/j.beem.2016.02.007,
- ↑ Vinay, Robbins and Cotran pathologic basis of disease, Philadelphia, PA:Elsevier, 2015,
- ↑ Juul, Kristian Vincents, Antidiuretic effect of desmopressin taken in the afternoon: preliminary evidence that desmopressin delays the onset of the nocturnal polyuria in patients with nocturnal polyuria and 24-h polyuria, Nephrology Dialysis Transplantation, 2011, Vol. 26(Issue: 8), pp. 2606–2612, DOI: 10.1093/ndt/gfq820,
- ↑ Fenske, W, Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study, American Journal of Medicine, 2010, Vol. 123(Issue: 7), pp. 652–657, DOI: 10.1016/j.amjmed.2010.01.022,
- ↑ Behan, L. A., The pathophysiology and management of hyponatraemia in cancer, Journal of Clinical Pathology, 2008, Vol. 61(Issue: 2), pp. 234–241, DOI: 10.1136/jcp.2007.052662,
- ↑ Adrogué, H. J., Malignant hypertension and hypertensive emergencies, Journal of the American Society of Nephrology, 2006, Vol. 17(Issue: 2), pp. 277–282, DOI: 10.1681/ASN.2005111185,
- ↑ Juul, Kristian Vincents, Antidiuretic effect of desmopressin taken in the afternoon: preliminary evidence that desmopressin delays the onset of the nocturnal polyuria in patients with nocturnal polyuria and 24-h polyuria, Nephrology Dialysis Transplantation, 2011, Vol. 26(Issue: 8), pp. 2606–2612, DOI: 10.1093/ndt/gfq820,
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