Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone (ADH), or vasopressin, a hormone that helps the kidneys and body conserve the correct amount of water. Normally, ADH controls the kidneys' output of urine. It is secreted by the hypothalamus (a small gland located at the base of the brain), stored in the pituitary gland, and then released into the bloodstream. ADH is secreted to decrease the amount of urine output so that dehydration does not occur. Diabetes insipidus, however, causes excessive production of very diluted urine and excessive thirst. The disease is categorized into groups:
Central diabetes insipidus. An insufficient production or secretion of ADH; can be a result of damage to the hypothalamus or pituitary gland caused by head injuries, genetic disorders, and other diseases.
Nephrogenic diabetes insipidus. A lack of kidney response to normal levels of ADH can be caused by drugs or chronic disorders, such as kidney failure, sickle cell disease, or polycystic kidney disease. It can also be genetic.
Diabetes insipidus can be caused by several conditions, including the following:
Malfunctioning hypothalamus (that produces too little ADH)
Malfunctioning pituitary gland (that fails to release ADH into the bloodstream)
Damage to hypothalamus or pituitary gland during surgery
Blockage in the arteries leading to the brain
Encephalitis (inflammation of the brain)
Meningitis (inflammation of the meninges, the membranes that cover the brain and spinal cord)
Sarcoidosis (a rare inflammation of the lymph nodes and other tissues throughout the body)
Certain drugs like lithium
The following are the most common symptoms of diabetes insipidus. However, each child may experience symptoms differently. Symptoms may include:
Excessive urine production
Infants with diabetes insipidus may also exhibit the following symptoms:
Failure to grow
The symptoms of diabetes insipidus may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.
In addition to a complete medical history and physical examination, including the child's daily fluid intake, dietary intake, and voiding (bowel and bladder elimination) patterns, diagnostic procedures for diabetes insipidus may include:
Water deprivation test. To observe if dehydration occurs. This test must only be done in the hospital.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; to check for pituitary abnormalities.
If left untreated in children, diabetes insipidus can lead to brain damage, impaired mental function, intellectual disability, hyperactivity, short attention span, and/or restlessness. Treatment for diabetes insipidus depends on what is causing the disease. Treating the cause usually treats the diabetes insipidus. Specific treatment for diabetes insipidus will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Extent of the disease
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include modified antidiuretic hormone medications (often taken as a pill, injection, or nasal spray), or medications that stimulate the production of the antidiuretic hormone such as NSAIDs or chlorpropamide. In addition, persons with diabetes insipidus must maintain adequate fluid intake to compensate for the excessive urinary output.. Although children with the disease also need to drink plenty of fluids, care should be taken to monitor sodium intake in their fluids.
Diabetes insipidus can be a temporary or a permanent condition, depending on what is causing the disease. Children with central diabetes insipidus, with proper management, can lead full, healthy lives. Children with nephrogenic diabetes insipidus can also lead relatively normal lives with proper medical care and management, especially if the medical care is started early.