Diabetes insipidus - central
Central diabetes insipidus is a rare condition that involves extreme thirst and excessive urination.
Central diabetes insipidus
Central diabetes insipidus occurs when the body has a lower than normal amount of 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 at the base of the brain.
ADH controls the amount of water excreted in urine. Without ADH, the kidneys do not work properly to keep enough water in the body. The result is a rapid loss of water from the body in the form of dilute urine. This results in the need to drink large amounts of water due to extreme thirst and to make up for excessive water loss in the urine (as much as 4 gallons a day).
The reduced level of ADH may be caused by damage to the hypothalamus or pituitary gland. This damage may be due to surgery, infection, inflammation, tumor, or injury to the brain.
Sometimes the cause is unknown. In rare cases, central diabetes insipidus is caused by a genetic problem.
Symptoms of central diabetes insipidus include:
- Increased urine production
- Excessive thirst
- Confusion and changes in alertness due to dehydration and higher than normal sodium level in the body, if the person is unable to drink
Exams and Tests
The health care provider will ask about your medical history and symptoms.
Tests that may be ordered include:
The cause of the underlying condition will be treated.
Vasopressin (desmopressin, DDAVP) is given either as a nasal spray, tablets, or injections. This controls urine output and fluid balance and prevents dehydration.
In mild cases, drinking more water may be all that is needed. If the body's thirst control is not working (for example, if the hypothalamus is damaged), a prescription for a certain amount of water intake may also be needed to ensure proper hydration.
Outcome depends on the cause. If treated, central diabetes insipidus usually does not cause severe problems or result in early death.
Not drinking enough fluids can lead to dehydration and electrolyte imbalance.
When taking vasopressin and your body's thirst control is not normal, drinking more fluids than your body needs can cause dangerous electrolyte imbalance.
When to Contact a Medical Professional
Call your health care provider if you develop symptoms of central diabetes insipidus.
If you have central diabetes insipidus, contact your health care provider if frequent urination or extreme thirst return.
Many of the cases may not be preventable. Prompt treatment of infections, tumors, and injuries may reduce risk.
Robinson AL, Verbalis JG. Posterior Pituitary. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 10.
Verbalis JG. Disorders of water balance. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 15.
Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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