Diabetes insipidus causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Central DI

The most common form of serious DI, central DI, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids.

Nephrogenic DI

Nephrogenic DI results when the kidneys are unable to respond to ADH. The kidneys’ ability to respond to ADH can be impaired by drugs—like lithium, for example—and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic DI is never discovered. Desmopressin will not work for this form of DI. Instead, a person with nephrogenic DI may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times.

Dipsogenic DI

Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid overload can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain. Scientists have not yet found an effective treatment for dipsogenic DI.

Gestational DI

Gestational DI occurs only during pregnancy and results when an enzyme made by the placenta destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that develops with the fetus. The placenta allows exchange of nutrients and waste products between mother and fetus.Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.

Common causes

• Idiopathic: 30% to 50% of all cases

• Hypophysectomy

• Head injury, especially basal skull fractures

• Craniopharyngioma

• Hypothalamic tumors, Pineal tumors

• Metastases (especially lung and breast)

• Lymphoma

Causes by Organ System

Cardiovascular	Hypovolemic shock
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Amphotericin B, Demeclocycline, Lithium , Radiation - for CNS and nasopharyngeal malignancies , Pituitary radiation , Netilmicin , Kanamycin, Carbamazepine , Amikacin
Ear Nose Throat	No underlying causes
Endocrine	Ischemia of the pitutary gland , Sheehan syndrome , Pituitary tumour , Panhypopituitarism , lymphocytic hypophysitis , Familial hypopituitarism , congenital nephrogenic , Congenital hypopituitarism , Apoplexy , pituitary cysts
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	Inherited genetic kidney disorders , Genetic diseases - pit-1 mutation
Hematologic	Sickle cell disease , Langerhans cell histiocytosis
Iatrogenic	Neurosurgery , Pituitary surgery
Infectious Disease	Tuberculous meningitis , Meningoencephalitis , Infections
Musculoskeletal / Ortho	No underlying causes
Neurologic	Dipsogenic diabetes insipidus , Ischemic encephalopathy , Subarachnoid hemorrhage , Mass lesions hypothalamus , Ischemic stroke , Intracranial space-occupying lesion , Intracranial bleeding , Hypoxic encephalopathy , Hypothalamic radiation , Brain aneurysm
Nutritional / Metabolic	Hypercalcemia , hemochromatosis , Anorexia nervosa
Obstetric/Gynecologic	Gestational diabetes insipidus
Oncologic	Pituitary Cancer , pituitary adenomas , malignant tumors infilterating hypothalamus from lung and breast , Histiocytosis , Craniopharyngioma
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Polycystic kidney disease, Renal failure , Interstitial nephritis , Hypokalaemia , Hypercalcaemia
Rheum / Immune / Allergy	Sarcoidosis , Autoimmune Hypophysitis , Autoimmune Diabetes Insipidus
Sexual	No underlying causes
Trauma	Head injury , Trauma - fracture of skull base
Urologic	Partial blockage of the ureters
Dental	No underlying causes
Miscellaneous	Dehydration , Wolfram syndrome , Sicca syndrome , Septo-optic dysplasia , Infiltrative lesions , Idiopathic , Hand-Schuller-Christian Syndrome , Familial CDI , Erdheim-Chester disease , DIDMOAD syndrome , Anophthalmia -- hypyothalamo-pituitary insufficiency , Anophthalmia -- hypothalamo-pituitary insufficiency , Amyloidosis

Causes in Alphabetical Order

Amikacin Amphotericin B Amyloidosis Anophthalmia -- hypothalamo-pituitary insufficiency Anophthalmia -- hypyothalamo-pituitary insufficiency Anorexia nervosa Apoplexy Autoimmune Diabetes Insipidus Autoimmune Hypophysitis Brain aneurysm Carbamazepine Congenital hypopituitarism Craniopharyngioma Diabetes insipidus, congenital nephrogenic DIDMOAD syndrome Erdheim-Chester disease Familial CDI Familial hypopituitarism Genetic diseases - pit-1 mutation Hand-Schuller-Christian Syndrome Head injury

Hemochromatosis Histiocytosis Hypercalcaemia Hypokalaemia Hypothalamic radiation Hypoxic encephalopathy Idiopathic Infections Infiltrative lesions Pituitary, hypothalamu Inherited genetic kidney disorders Interstitial nephritis Intracranial bleeding Intracranial space-occupying lesion Ischemic stroke Kanamycin Langerhans cell histiocytosis Lithium Lymphocytic hypophysitis Malignant tumors infilterating hypothalamus from lung, breast Mass lesions hypothalamus Meningoencephalitis

Netilmicin Neurosurgery Panhypopituitarism pituitary adenomas Pituitary Cancer Pituitary radiation Pituitary surgery Pituitary cysts Pituitary tumour Post-supraventricular tachycardia Radiation - for CNS and nasopharyngeal malignancies Sarcoidosis Septo-optic dysplasia Sheehan syndrome Sheehan syndrome Sicca syndrome Sickle cell disease Subarachnoid hemorrhage Trauma - fracture of skull base Tuberculous meningitis Wolfram syndrome

References