This document provides information about diabetes insipidus, including its signs and symptoms, causes, types, diagnosis, and treatment. There are four main types of diabetes insipidus: nephrogenic, central, gestational, and dipsogenic. Central diabetes insipidus is caused by a lack of the antidiuretic hormone vasopressin, while nephrogenic diabetes insipidus occurs when the kidneys do not respond properly to vasopressin. Diagnosis involves tests of blood and urine as well as a water deprivation test. Treatment depends on the type but may include vasopressin supplements or medications to reduce urine production.

1. DIABETES INSIPIDUS
TABLE OF CONTENTS
DECLARATION………………………………………………………………………...ii
FACULTY GUIDED APPROVAL……………………………………………….…iii
ACKNOWLEDGEMENT…………………………………………………………….iv
LIST OF FIGURES……………………………………………………………………..vi
INTRODUCTION……………………………………………………………………….6
SIGNS AND SYMPTOMS…………………………………………………………..8
CAUSES………………………………………………………………………………….10
TYPES…………………………………………………………………………………….11
 NEPHROGENIC……………………………………………………………….11
 CENTRAL………………………………………………………………………..13
 GESTATIONAL………………………………………………………………..15
 DIPSOGENIC…………………………………………………………………..15
DIAGNOSIS…………………………………………………………………………….16
TREATMENT…………………………………………………………………………..18

2. REFERENCES………………………………………………………………………….
INTRODUCTION
Diabetes insipidus is a rare disorder that manifests itself when a
person's kidneys pass an abnormally large volume of urine.
It is an uncommon condition in which kidneys are unable to prevent the
excretion of water.
Diabetes insipidus affects about one in 25,000 people in the general
population. Adults are more likely to develop the condition but it can
occur at any age.
Diabetes insipidus (DI) is also defined as the passage of large volumes
(>3 L/24 hr) of dilute urine (< 300 mOsm/kg). People with diabetes
insipidus have normal blood glucose levels; however, their kidneys
cannot balance fluid in the body.
In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts
of urine a day. As a result, a person with diabetes insipidus may feel the
need to drink large amounts of liquids.
The condition is caused by a hormonal abnormality and isn't related to
diabetes.The hormone vasopressin, also called antidiuretic hormone,
controls the fluid removal rate through urination. The hypothalamus, a

3. small gland located at the base of the brain, produces vasopressin. The
nearby pituitary gland stores the vasopressin and releases it into the
bloodstream when the body has a low fluid level. Vasopressin signals
the kidneys to absorb less fluid from the bloodstream, resulting in less
urine. When the body has extra fluid, the pituitary gland releases
smaller amounts of vasopressin, and sometimes none, so the kidneys
remove more fluid from the bloodstream and produce more urine. The
quantity of water retained in the body is closely controlled by several
mechanisms, one of the most important of which is a hormone (a
chemical secreted into the blood by an endocrine gland) secreted by
the posterior pituitary gland, a structure which lies deep within the
brain. This is called vasopressin or anti-diuretic hormone (ADH) because
its function is to control the loss of water as urine from the kidneys.

4. SIGNS AND SYMPTOMS
The main complication of diabetes insipidus is dehydration if fluid loss
is greater than liquid intake.
 Thirst(polydipsia)
 dry skin
 fatigue

5.  sluggishness
 dizziness
 confusion
 nausea
 bed wetting
 frequent urination
 headace
 weight loss
 slower than expected growth
 loss of appetite
 hyperthermia(high body temperature)
In extreme conditions, if fluid is not immediately available they will
drink from flower vases, lavatory cisterns, puddles or anywhere else.
In general affected children remain well but if they become
dehydrated they may seem obviously ill.

6. CAUSES

7. Diabetes insipidus occurs when your body can't regulate how it
handles fluids. Normally, your kidneys remove excess body fluids
from your bloodstream. This fluid waste is temporarily stored in your
bladder as urine, before you urinate. The volume and composition of
your body fluids remain balanced through a combination of oral
intake and excretion by the kidneys. The rate of fluid excreted by
your kidneys is greatly influenced by the production of anti-diuretic
hormone (ADH), also known as vasopressin.
Our body makes ADH in the hypothalamus and stores the hormone
in your pituitary gland, a small gland located in the base of your
brain. ADH is released into your bloodstream when your body starts
to become dehydrated. ADH then concentrates the urine by
triggering the kidney tubules to release water back into your
bloodstream rather than excreting as much water into your urine.
The increased loss of urine (polyuria) is reflected by a greatly
increased thirst and fluid intake (polydipsia) but eventually it may
become impossible to take in enough water and the person with this
condition will become dehydrated.
TYPES OF DIABETES INSIPIDUS

8. There are four types of diabetes insipidus :
1. NEPHROGENIC
 CONGENITAL NEPHROGENIC
 AQUIRED NEPHROGENIC
2. CENTRAL
3. GESTATIONAL
4. DIPSOGENIC
NEPHROGENIC DIABETESINSIPIDUS
The term nephrogenic refers to the kidneys. In nephrogenic diabetes
insipidus, ADH is still being released by your brain but your kidneys
become resistant to the effects of ADH. This means that ADH is not
able to work properly to allow your kidneys to concentrate your
urine.
There are two form of nephrogenic –
Congenital nephrogenic diabetes insipidus
Congenital diabetes Insipidus is present from birth and is caused by
several genes that cause the kidneys of the foetus to form
improperly. Kidneys contain cells called nephrons which regulate
what water is passed by urine and what water is reabsorbed back
into the body. These nephrons react to the ADH released by the
hypothalamus, and if they are damaged, they can end up 'ignoring'
the ADH, leading to constant production of urine.

9. Deformations can occur in the body by the presence of several rogue
genes. This mutation can only be passed from unaffected mothers to
their sons. However, this very rarely happens, apparently affecting
just 1 in 250,000 births.
There is an even rarer gene mutation that can cause nephrogenic
diabetes insipidus in both males and females.
Acquired nephrogenic diabetes insipidus
Acquired diabetes insipidus occurs after birth as a result of an
outside factor damaging the kidneys and leading to the excessive
urination.
Lithium is used in some medications, particularly for bi-polar
disorder, and long term intake of lithium can cause damage to the
nephrons in the kidneys. Being taken off lithium however, can
restore normal kidney function if it is diagnosed early, so having
kidney function tests every three months is advised by the NHS if you
are on lithium containing medication.
Infections, blockages (such as kidney stones) or other forms of
damage to the kidney could lead to diabetes insipidus

10. CENTRAL DIABETES INSIPIDUS
Neurogenic diabetes Insipidus, or central and cranial diabetes
insipidus occurs when your brain produces or releases a reduced
amount of ADH. ADH usually helps your kidneys to concentrate your
urine. If less ADH is released, you will pass an increased volume of
dilute urine.
Cranial diabetes insipidus can occur if your hypothalamus or pituitary
gland is damaged. This causes a reduction in production and release
of ADH. The causes of cranial diabetes insipidus include:
 Head injury.

11.  Cancerous (malignant) or non-cancerous (benign) tumours of your
brain or pituitary gland.
 Surgery to your brain around the region of the pituitary gland and
hypothalamus.
 Idiopathic diabetes insipidus. In this condition the cells in your
hypothalamus become damaged and stop producing ADH. In
many cases, the damage is thought to be due to an autoimmune
problem. Normally, your body makes antibodies to fight infections
- for example, when you catch a cold or have a sore throat. These
antibodies help to kill the germs (bacteria or viruses) causing the
infection. In autoimmune diseases your body makes similar
antibodies (autoantibodies) that attack its normal cells. In this
case, the cells of your hypothalamus are attacked by
autoantibodies.
 Infections including encephalitis and meningitis.
 Some rare inherited conditions.
Cranial diabetes insipidus may just be a problem on its own.
However, sometimes it can occur with other problems because the
production of other hormones that are released by the pituitary
gland is also affected. If cranial diabetes insipidus is caused by a head
injury or surgery to your brain, it may only be a problem for a short
period of time, perhaps a few weeks.

12. Gestational diabetes insipidus
During pregnancy, the uterus produces vasopressinase which can
break down ADH. The nephrones in the kidneys do not receive the
'stop making urine' message and continue to produce it.
Usually Gestational diabetes insipidus will disappear after the
pregnancy.
Dipsogenic diabetes insipidus
Some cases of diabetes insipidus occur because of an issue with the
thirst function. Similar damage to the hypothalamus that causes
neurogenic diabetes insipidus can also result in a malfunction to the
thirst mechanism, resulting in thirst that won't go away. This will
lead to a constant need to drink, which in turn can lead to excessive
urination.

13. DIAGNONIS
Blood and urine tests
For example:
 To check the levels of sodium and potassium salts in your blood.
These can be high in diabetes insipidus.
 To check the level of sugar (glucose) in your blood and urine to
exclude diabetes mellitus.
A water deprivation test
This is a special test where you must not drink any water or other
fluids for a certain period of time (usually around 6-8 hours). The
volume of urine that you produce will be measured to see if there is
any change in the amount. If your body is working normally, the
amount of urine that you produce should reduce if you have not
drunk anything for a long time. However, if you have diabetes
insipidus, there will be little change in your urine production.
Antidiuretic hormone test
After the period of fluid deprivation, you may then be given a
medicine that is similar to ADH. If you have cranial diabetes
insipidus, once you have been given this medicine, the amount of
urine that you produce should reduce. The medicine is replacing the
ADH that you are lacking. If you have nephrogenic diabetes insipidus,
you may have no, or only a small, response to the medicine.

14. Other tests
Other tests may sometimes be suggested to look for possible causes
of diabetes insipidus. For example, an MRI scan of your brain and
pituitary gland.

15. TREATMENT
Treatment of diabetes insipidus depends on what form of the
condition you have. Treatment options for the most common types
of diabetes insipidus include:
 Central diabetes insipidus. Because the cause of this form of
diabetes insipidus is a lack of anti-diuretic hormone (ADH),
treatment is usually with a synthetic hormone called
desmopressin. You can take desmopressin as a nasal spray, as oral
tablets or by injection.
The synthetic hormone will eliminate the increase in urination. For
most people with this form of the condition, desmopressin is safe
and effective. If the condition is caused by an abnormality in the
pituitary gland or hypothalamus (such as a tumor), your doctor will
first treat the abnormality.
Desmopressin should be considered a medication you take as
needed. This is because in most people, the deficiency of ADH is not
complete, and the amount made by the body can vary day to day.
Taking more desmopressin than needed can result in too much
water retention and low sodium levels in the blood. Symptoms of
low sodium include lethargy, headache, nausea and, in severe cases,
seizures.
In mild cases of central diabetes insipidus, you may need only to
increase your water intake.

16.  Nephrogenic diabetes insipidus. This condition is the result of
your kidneys not properly responding to ADH, so desmopressin is
not a treatment option. Instead, your doctor may prescribe a low-
salt diet to help reduce the amount of urine your kidneys make.
You'll also need to drink enough water to avoid dehydration.
The drug hydrochlorothiazide, used alone or with other medications,
may improve symptoms. Although hydrochlorothiazide is a diuretic
(usually used to increase urine output), in some cases it can reduce
urine output for people with nephrogenic diabetes insipidus.
If symptoms from nephrogenic diabetes insipidus are due to
medications you're taking, stopping these medicines may help;
however, don't stop taking any medication without first talking to
your doctor.
 Gestational diabetes insipidus. Treatment for most cases of
gestational diabetes insipidus is with the synthetic hormone
desmopressin. In rare cases, this form of the condition is caused
by an abnormality in the thirst mechanism. In these rare cases,
doctors don't prescribe desmopressin.