Diabetes insipidus causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Causes
Central DI
CDI is caused by the destruction or degeneration of neurons originating in the supraoptic and paraventricular nuclei. 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 such as[1];
- Local inflammatory or autoimmune diseases
- Vascular diseases
- Langerhans cell histiocytosis (LCH)
- Sarcoidosis
- Germinoma/craniopharyngioma
- Trauma resulting from surgery or an accident
- Metastases and midline cerebral and cranial malformations
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
- Chronic disorders including
- polycystic kidney disease
- sickle cell disease
- kidney failure
- Partial blockage of the ureters
- Inherited genetic disorders
- Idiopathic causes
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
- Head injury, especially basal skull fractures
- Hypothalamic tumors, Pineal tumors
- Metastases (especially lung and breast)
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
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References
- ↑ Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S; et al. (2000). "Central diabetes insipidus in children and young adults". N Engl J Med. 343 (14): 998–1007. doi:10.1056/NEJM200010053431403. PMID 11018166.