Diabetes Insipidus

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

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