Diabetes Insipidus

aciltip-10-2-kapak-wos

Kadir YENALa , Melih ÇAMCIb

aAnkara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye
bAnkara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Department of Emergency Medicine, Ankara, Türkiye

ABSTRACT
Diabetes insipidus (DI) is an endocrine condition involving the posterior pituitary peptide hormone, antidiuretic hormone (ADH). ADH exerts its effects on the distal convoluted tubule and collecting duct of the nephron by upregulating aquaporin-2 channels (AQP2) on the cellular apical membrane surface. DI is marked by expelling excessive quantities of highly dilute urine, extreme thirst, and craving for cold water. The two main classifications of DI are central diabetes insipidus (CDI), characterized by a deficiency of the posterior pituitary gland to release ADH, and nephrogenic diabetes insipidus (NDI), characterized by the terminal distal convoluted tubule and collecting duct resistance to ADH. Treatment of DI is dependent on the disease classification, but severe complications may arise if not tended to appropriately. The most important step in symptom management is maintaining fluid intake ahead of fluid loss with emphasis placed on preserving the quality of life. The most common treatment of CDI and gestational DI is the administration of synthetic ADH, desmopressin (DDAVP). Nephrogenic treatment, although more challenging, requires discontinuation of medications as well as maintaining a renal-friendly diet to prevent hypernatremia. Central and nephrogenic subtypes of DI share a paradoxical treatment in thiazide diuretics.
Keywords: Diabetes insipidus; antidiuretic hormone; vasopressin

Referanslar

  1. Fenske W, Allolio B. Clinical review: Current state and future perspectives in the diagnosis of diabetes insipidus: a clinical review. J Clin Endocrinol Metab. 2012;97(10):3426-37. [Crossref]  [PubMed]
  2. Grace M, Balachandran V, Preethy. Menon S. Idiopathic central diabetes Insipidus. Indian J Med Sci. 2011;65(10):452-5. [Crossref]  [PubMed]
  3. Kalra S, Zargar AH, Jain SM, Sethi B, Chowdhury S, Singh AK, et al. Diabetes insipidus: The other diabetes. Indian J Endocrinol Metab. 2016;20(1):9-21. [Crossref]  [PubMed]  [PMC]
  4. Schernthaner-Reiter MH, Stratakis CA, Luger A. Genetics of Diabetes Insipidus. Endocrinol Metab Clin North Am. 2017;46(2):305-34. [Crossref]  [PubMed]
  5. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. 2000;354(23):2473-83. [Crossref]  [PubMed]
  6. Nielsen S, Marples D, Frøkiaer J, Knepper M, Agre P. The aquaporin family of water channels in kidney: an update on physiology and pathophysiology of aquaporin-2. Kidney Int. 1996;49(6):1718-23. [Crossref]  [PubMed]
  7. Merck Manual Professional Version. Central Diabetes Insipidus. (cited: 7/12/2022). Available from: [Link]
  8. National Health Service. Diabetes Insipidus (Cited: 7/12/2022). Available from: [Link]
  9. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Insipidus. (Cited: 7/12/2022) Available from: [Link]
  10. National Library of Medicine. Nephrogenic Diabetes Insipidus. (cited: 7/12/2022). Available from: [Link]
  11. Refardt J, Winzeler B, Christ-Crain M. Diabetes Insipidus: An Update. Endocrinol Metab Clin North Am. 2020;49(3):517-31. [Crossref]  [PubMed]
  12. Refardt J, Winzeler B, Christ-Crain M. Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clin Endocrinol (Oxf). 2019;91(1):22-32. [Crossref]  [PubMed]  [PMC]
  13. Refardt J. Diagnosis and differential diagnosis of diabetes insipidus: Update. Best Pract Res Clin Endocrinol Metab. 2020; 34(5):101398. [Crossref]  [PubMed]
  14. Christ-Crain M, Bichet DG, Fenske WK, Goldman MB, Rittig S, Verbalis JG, et al. Diabetes insipidus. Nat Rev Dis Primers. 2019;8;5(1):54. [Crossref]  [PubMed]
  15. Ananthakrishnan S. Gestational diabetes insipidus: Diagnosis and management. Best Pract Res Clin Endocrinol Metab. 2020;34(5):101384. [Crossref]  [PubMed]
  16. Zerbe RL, Robertson GL. A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria. N Engl J Med. 1981;305(26):1539-46. [Crossref]  [PubMed]
  17. Bichet D, Sterns RH, Emmett M, Wolfsdorf JI. Treatment of Central Diabetes Insipidus. Waltham, MA: UpToDate; 2019.
  18. Babey M, Kopp P, Robertson GL. Familial forms of diabetes insipidus: clinical and molecular characteristics. Nat Rev Endocrinol. 2011;7(12):701-14. [Crossref]  [PubMed]
  19. Bockenhauer D, van't Hoff W, Dattani M, Lehnhardt A, Subtirelu M, Hildebrandt F, et al. Secondary nephrogenic diabetes insipidus as a complication of inherited renal diseases. Nephron Physiol. 2010;116(4):p23-9. [Crossref]  [PubMed]  [PMC]
  20. Los EL, Deen PM, Robben JH. Potential of nonpeptide (ant)agonists to rescue vasopressin V2 receptor mutants for the treatment of X-linked nephrogenic diabetes insipidus. J Neuroendocrinol. 2010;22(5):393-9. [Crossref]  [PubMed]
  21. Kim GH, Lee JW, Oh YK, Chang HR, Joo KW, Na KY, et al. Antidiuretic effect of hydrochlorothiazide in lithium-induced nephrogenic diabetes insipidus is associated with upregulation of aquaporin-2, Na-Cl co-transporter, and epithelial sodium channel. J Am Soc Nephrol. 2004;15(11):2836-43. [Crossref]  [PubMed]
  22. Di Iorgi N, Napoli F, Allegri AE, Olivieri I, Bertelli E, Gallizia A, et al. Diabetes insipidus--diagnosis and management. Horm Res Paediatr. 2012;77(2):69-84. [Crossref]  [PubMed]
  23. Sands JM, Bichet DG; American College of Physicians; American Physiological Society. Nephrogenic diabetes insipidus. Ann Intern Med. 2006;144(3):186-94. [Crossref]  [PubMed]
  24. Bichet D, Sterns RH, Mattoo TK, Forman JP. Treatment of Nephrogenic Diabetes Insipidus. UpToDate. 2019.
  25. Procino G, Milano S, Carmosino M, Barbieri C, Nicoletti MC, Li JH, et al. Combination of secretin and fluvastatin ameliorates the polyuria associated with X-linked nephrogenic diabetes insipidus in mice. Kidney Int. 2014;86(1):127-38. [Crossref]  [PubMed]  [PMC]
  26. Sailer C, Winzeler B, Christ-Crain M. Primary polydipsia in the medical and psychiatric patient: characteristics, complications and therapy. Swiss Med Wkly. 2017;147:w14514. [Crossref]
  27. Hui C, Radbel JM: Diabetes insipidus. StatPearls, Treasure Island, FL; 2020.
  28. Kahn A, Brachet E, Blum D. Controlled fall in natremia and risk of seizures in hypertonic dehydration. Intensive Care Med. 1979;5(1):27-31. [Crossref]  [PubMed]
  29. Cansick J, Rees L, Koffman G, Van't Hoff W, Bockenhauer D. A fatal case of cerebral oedema with hyponatraemia and massive polyuria after renal transplantation. Pediatr Nephrol. 2009;24(6):1231-4. [Crossref]  [PubMed]
  30. Sterns RH. Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med. 2015;372(1):55-65. [Crossref]  [PubMed]
  31. Fang C, Mao J, Dai Y, Xia Y, Fu H, Chen Y, et al. Fluid management of hypernatraemic dehydration to prevent cerebral oedema: a retrospective case control study of 97 children in China. J Paediatr Child Health. 2010 Jun;46(6):301-3. [Crossref]  [PubMed]
  32. Meyer E. Über Diabetes insipidus und andere Polyurien. Deutsch. Arch. klin. Med. 1905;83(1).
  33. .Crawford JD, Kennedy GC. Chlorothiazid in diabetes insipidus. Nature. 1959;183(4665):891-2. [Crossref]  [PubMed]
  34. Bockenhauer D, Medlar AJ, Ashton E, Kleta R, Lench N. Genetic testing in renal disease. Pediatr Nephrol. 2012;27(6):873-83. [Crossref]  [PubMed]
  35. Bernier V, Morello JP, Zarruk A, Debrand N, Salahpour A, Lonergan M, et al. Pharmacologic chaperones as a potential treatment for X-linked nephrogenic diabetes insipidus. J Am Soc Nephrol. 2006 17(1):232-43. Erratum in: J Am Soc Nephrol. 2006;17(2):591. [Crossref]  [PubMed]