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Dipsogenic Diabetes Insipidus Definition

Diabetes Insipidus

Diabetes Insipidus

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Diabetes Insipidus article more useful, or one of our other health articles. Diabetes insipidus (DI) is a condition caused by hyposecretion of, or insensitivity to the effects of, antidiuretic hormone (ADH), also known as arginine vasopressin (AVP). ADH is synthesised in the hypothalamus and transported as neurosecretory vesicles to the posterior pituitary. There it is released into the circulation, governed by plasma osmolality. Its deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate urine because of resistance to ADH in the kidney. There are two other forms of DI (both caused by deficiencies in ADH; however, the deficiencies do not result from a defect in the neurohypophysis or kidneys): Gestational DI: results from degradation of vasopressin by a placental vasopressinase. Gestational DI may be associated with increased complications of pregnancy, including pre-eclampsia.[1] Primary polydipsia (dipsogenic DI): caused by a primary defect in osmoregulation of thirst. Dipsogenic DI has been reported in tuberculous meningitis, multiple sclerosis and neurosarcoidosis. The combined prevalence of cranial DI and nephrogenic D Continue reading >>

What Is Diabetes Insipidus? Its Symptoms, Causes, And Treatment

What Is Diabetes Insipidus? Its Symptoms, Causes, And Treatment

Talk of diabetes and most of us can only think of diabetes mellitus which is caused when either the body is not producing enough insulin or the insulin so produced is not utilized effectively by the body. Diabetes mellitus is sort of synonymous to the very meaning of diabetes given its popularity and complications. However, not many people know about diabetes insipidus. Diabetes insipidus is a rare disease which is characterized by the patient feeling extremely thirsty and as a result, there is a greater need for urination. Although these symptoms can be experienced in diabetes mellitus as well, there is no increase in the levels of blood glucose or blood sugar in this case which makes the disease different from diabetes mellitus that we all know about. In this article, we shall analyze, deep dive, and find out more about diabetes insipidus, the symptoms, causes, and subsequent treatment of diabetes insipidus. So, join in for the article “What is Diabetes Insipidus? It’s Symptoms, Causes, and Treatment.” What is the Meaning of Diabetes Insipidus? Diabetes insipidus is very different from diabetes mellitus. When we talk about diabetes, we are actually referring to diabetes mellitus in which our body experiences elevated levels of blood glucose or blood sugar. However, diabetes insipidus is a condition in which the patient experiences excessive thirst and as a result, the need for urination also increases. Hence this is a condition caused when the body has problems either in the pituitary gland or the kidneys. Hence, Diabetes insipidus is a rare condition which affects the kidneys of the patient’s body by making the patient urinate large volumes of urine that are insipid meaning odorless. The major problem that occurs with this condition is the problem of dehydrat Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Over the past two decades our understanding of the mechanisms that control water balance in health and disease has increased substantially. Following the establishment of reliable assay techniques to measure circulating vasopressin, the application of molecular biological methods to define hormonal and receptor abnormalities, and a greater knowledge of intracellular events within the renal tubular cells, it is now possible to characterise disorders of water balance more accurately. The physiology of water homeostasis is briefly discussed before the pathophysiology, diagnosis, and treatment of diabetes insipidus are described in detail. Physiology of water homeostasis It is essential that body water, both intracellular and extracellular, remains stable to allow normal cellular functions to take place. In humans, the maintenance of normal water balance is achieved principally by three interrelated determinants: vasopressin, thirst, and the kidneys. The secretion of vasopressin from the posterior pituitary is under very precise control. Small changes in blood solute concentration (plasma osmolality) regulate vasopressin release.1 An increase in plasma osmolality, usually indicating a loss of extracellular water, stimulates vasopressin secretion and, conversely, a decrease in plasma osmolality inhibits its release into the systemic circulation (fig 1). Vasopressin then acts on its major target organ, the kidneys. The hormone binds to its V2 receptor (the antidiuretic receptor) on the basal aspect of the renal collecting tubular cell to activate an adenyl cyclase system that stimulates intracellular protein kinases. These, in turn, control the arrangement and insertion of “water channel” proteins (aquaporin 2) into the cell membrane to allow water to pass from the lumen Continue reading >>

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes insipidus is a condition where the body loses too much fluid through urination, causing a significant risk of dangerous dehydration as well as a range of illnesses and conditions. There are two forms of the disease: nephrogenic diabetes insipidus and central diabetes insipidus (also known as neurogenic diabetes insipidus). A number of factors have been linked to the development of diabetes insipidus, which may also occur in pregnancy or with the use of certain medications. Establishing the cause of the problem can help determine the most appropriate treatment to support the regulation of water balance in the body. Diabetes insipidus is a condition that can be managed successfully. Contents of this article: What is diabetes insipidus? An uncommon condition, diabetes insipidus is a disorder affecting the regulation of body fluid levels. Two key symptoms resemble those of the more common forms of diabetes that affect blood sugar levels (diabetes mellitus types 1 and 2).1-5 People with diabetes insipidus produce excessive amounts of urine (polyuria), resulting in frequent urination and, in turn, thirst (polydipsia). However, the underlying cause of these two symptoms is quite different from the causes in types 1 and 2 diabetes. In diabetes mellitus, elevated blood sugar prompts the production of large volumes of urine to help remove the excess sugar from the body. In diabetes insipidus, it is the body's water balance system itself that is not working properly. Here are some key points about diabetes insipidus. More detail and supporting information is in the body of this article. Diabetes insipidus is a condition where the body fails to properly control water balance, resulting in excessive urination. Diabetes insipidus can be caused by low or absent secretion of t Continue reading >>

Diabetes Insipidus: Celebrating A Century Of Vasopressin Therapy

Diabetes Insipidus: Celebrating A Century Of Vasopressin Therapy

Diabetes Insipidus: Celebrating a Century of Vasopressin Therapy Laboratory of Diabetes and Diabetes-Related Disorders (S.Q., S.G., J.R.), Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030 Albert Einstein College of Medicine (S.Q., J.R.), Yeshiva University, Bronx, New York 10461 Search for other works by this author on: Laboratory of Diabetes and Diabetes-Related Disorders (S.Q., S.G., J.R.), Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030 James J Peters VA Medical Center (S.G.), Mount Sinai Medical Center Health System, Bronx, New York 10029 Search for other works by this author on: Hpital du Sacr-Coeur de Montral (D.G.B.), Groupe des Protines Membranaires, Universit de Montral, Montral, Qubec, Canada H4J IC5 Search for other works by this author on: Laboratory of Diabetes and Diabetes-Related Disorders (S.Q., S.G., J.R.), Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030 Albert Einstein College of Medicine (S.Q., J.R.), Yeshiva University, Bronx, New York 10461 Hofstra North Shore-Long Island Jewish School of Medicine (J.R.), North Shore-Long Island Jewish Health System, Hempstead, New York 11549 Address all correspondence and requests for reprints to: Dr Jesse Roth, MD, FACP, Investigator, Feinstein Institute for Medical Research North Shore-Long Island Jewish Health System Albert Einstein College of Medicine, Yeshiva University, 14937 Powells Cove Boulevard, Whitestone, NY 11357. Endocrinology, Volume 155, Issue 12, 1 December 2014, Pages 46054621, Sana Qureshi, Sneha Galiveeti, Daniel G. Bichet, Jesse Roth; Diabetes Insipidus: Celebrating a Century of Vasopressin Therapy, Continue reading >>

What Is Diabetes Insipidus – Causes, Symptoms And Treatments

What Is Diabetes Insipidus – Causes, Symptoms And Treatments

The question, "What is diabetes insipidus?" may be new to you. Plenty has been written about its relative diabetes mellitus yet diabetes insipidus remains a bit more of a mystery. To define what is diabetes insipidus you could describe it as “a rare form of diabetes resulting from a deficiency of vasopressin (the pituitary hormone that regulates the kidneys); characterized by the chronic excretion of large amounts of pale dilute urine which results in dehydration and extreme thirst” (1). What is diabetes insipidus symptom profile? It is the presence of the large amounts of pale dilute urine that give diabetes insipidus the nickname water diabetes, which distinguishes it from diabetes mellitus which has been referred to as sugar diabetes. Other symptoms of diabetes insipidus include extreme thirst, urine that is not yellow but is pale and watery, and repeated trips to the bathroom including waking during the night to urinate or uncontrollable bedwetting accidents. What is diabetes insipidus caused by? There are 4 types of diabetes insipidus: Neurogenic diabetes insipidus, also know as central diabetes insipidus is the most common type and is caused by a lack of vasopressin (a.k.a. antidiuretic hormone or arginine vasopressin). Nephrogenic diabetes insipidus is the second most common type and is caused by an insensitivity of the kidneys to antidiuretic hormone Dipsogenic diabetes insipidus is caused by a defect in the thirst mechanism, which results in abnormal thirst and fluid intake that suppresses antidiuretic hormone secretion and increases urination. Gestational diabetes insipidus only occurs during pregnancy. Diabetes insipidus is primarily due to genetics, but can also be caused by brain tumors, head trauma, chronic meningitis, multiple sclerosis and hypercalca Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes Insipidus Definition Diabetes insipidus (DI) is a disorder that causes the patient to produce tremendous quantities of urine. The massively increased urine output is usually accompanied by intense thirst. Description The balance of fluid within the body is maintained through a number of mechanisms. One important chemical involved in fluid balance is called antidiuretic hormone (ADH). ADH is produced by the pituitary, a small gland located at the base of the brain. In a healthy person and under normal conditions, ADH is continuously released. ADH influences the amount of fluid that the kidneys reabsorb into the circulatory system and the amount of fluid that the kidneys pass out of the body in the form of urine. Production of ADH is regulated by the osmolality of the circulating blood. Osmolality refers to the concentration of dissolved chemicals (such as sodium, potassium, and chloride; together called solute) circulating in the fluid base of the blood (plasma). When there is very little fluid compared to the concentration of solute, the pituitary will increase ADH production. This tells the kidneys to retain more water and to decrease the amount of urine produced. As fluid is retained, the concentration of solute will normalize. At other times, when the fluid content of the blood is high in comparison to the concentration of solute, ADH production will decrease. The kidneys are then free to pass an increased amount of fluid out of the body in the urine. Again, this will allow the plasma osmolality to return to normal. Diabetes insipidus occurs when either the amount of ADH produced by the pituitary is below normal (central DI), or the kidneys' ability to respond to ADH is defective (nephrogenic DI). In either case, a person with DI will pass extraordinarily la Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, 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 Diabetes Insipidus Nephrogenic diabetes insipidus 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 diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus 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 Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>

Dipsogenic Diabetes Insipidus: A Newly Recognized Syndrome Caused By A Selective Defect In The Osmoregulation Of Thirst

Dipsogenic Diabetes Insipidus: A Newly Recognized Syndrome Caused By A Selective Defect In The Osmoregulation Of Thirst

Title: Dipsogenic Diabetes Insipidus: A Newly Recognized Syndrome Caused by a Selective Defect in the Osmoregulation of Thirst Author: Robertson, Gary Publisher: Transactions of the Association of American Physicians Date Published: January 01, 1987 Reference Number: 470 We describe three patients who have polydipsia and polyuria due to an abnormality in the osmoregulation of thirst. The clinical manifestations of the syndrome are similar to those of neurogenic diabetes insipidus. Thus, under basal conditions the patients have thirst, normal to high normal levels of plasma osmolality, and low levels of plasma vasopressin. Moreover, antidiuretic therapy greatly reduces thirst and polydipsia as well as polyuria. The only clinically distinguishing feature of the response is that thirst and water intake decrease less rapidly than water excretion. As a consequence, the patients with this syndrome develop variable degrees of dilutional hyponatremia and hypoosmolemia during treatment. The plasma vasopressin response to osmotic stimulation is relatively normal. In most of the patients, the osmotic threshold for vasopressin release is at the upper limit of normal, but this finding only explains their modest elevation in basal plasma osmolality. Thirst and water intake also change as a function of plasma osmolality. However, the threshold or "set" of the thirst osmostat appears to be abnormally low. The degree of downward resetting varies from patient to patient, but is always sufficient to stimulate thirst and water intake at levels of plasma osmolality below the normal range. This abnormality can account not only for the thirst and polyuria under basal conditions but also for the overhydration that occurs during antidiuretic therapy. The pathogenesis of the osmoregulatory abnor Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Tweet Diabetes insipidus, often shortened to DI, is a rare form of diabetes that is not related to blood sugar-related diabetes mellitus, but does share some of its signs and symptoms. Diabetes insipidus is simply excessive urination (polyuria) and complications thereof, caused by an antidiuretice hormone called a vasopressin. Read on to find out more about what diabetes insipidus is, how it affects the body, the different forms of the disease, and how it is diagnosed and treated. What are the symptoms of diabetes insipidus? Diabetes Insipidus leads to frequent urination, and this is the most common and clear symptom. In extreme cases, urination can be in excess of 20 litres per day. A secondary symptom is increased thirst, as a result of passing so much water. If this is not met, then dehydration can occur which, in turn, can lead to: Cracked skin Confusion Dizziness and even Unconsciousness Children suffering from the condition may become irritable or listless, with fever and vomiting also possible. How does diabetes insipidus compare with diabetes mellitus? Diabetes insipidus and diabetes mellitus should not be confused. The two conditions are unrelated, with diabetes insipidus a completely different type of illness. Diabetes mellitus is also far more common. Diabetes mellitus occurs due to insulin resistance or insulin deficiency and subsequent high blood glucose levels. Diabetes Insipidus on the other hand develops as a result of the stilted production of a hormone in the brain, which is released to stop the kidneys producing so much urine in order to retain water. Without this hormone, water is not retained and the kidneys constantly work to their maximum capacity. The word "Mellitus" tagged onto the main form of diabetes comes from an old word roughly meaning "to Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Definition: A disease that is characterized by frequent urination, excretion of large amounts of dilute URINE, and excessive THIRST. Etiologies of diabetes insipidus include deficiency of antidiuretic hormone (also known as ADH or VASOPRESSIN) secreted by the NEUROHYPOPHYSIS, impaired KIDNEY response to ADH, and impaired hypothalamic regulation of thirst. See Also Diabetes Mellitus Examples Diabetes Insipidus, Nephrogenic; Diabetes Insipidus, Neurogenic; Wolfram Syndrome To share this definition, click "text" (Facebook, Twitter) or "link" (blog, mail) then paste text link Continue reading >>

Diabetes Insipidus And Siadh

Diabetes Insipidus And Siadh

Sort 3 Mechanism where DI arises 1. Deficiency of VP: o hypothalamic diabetes insipidus (HDI) 2. Renal resistance to the antidiuretic action of VP: o nephrogenic diabetes insipidus (NDI) 3. Inappropriate, excessive water drinking: o dipsogenic diabetes insipidus (DDI) Hypothalamic DI Primary (Genetic) - Wolfram syndrome - AD - AR Secondary o Developmental syndromes - Septo-optic dysplasia - Lawrence-Moon-Biedel Syndrome o Trauma - Head injury - Post surgery (transcranial transphenoidal) oTumor - Craniopharyngioma - pinealoma - germinoma - metastases - pituitary macroadenoma o Inflammatory - Granulonulomas - Sarcoidosis - Histiocytosis - Meningitis - Infundibulo-neurohypophysitis - GBS o Vascular - Aneurysm - Infarction ( Sheehan syndrome; Sickle cell disease) o Pregnancy Nephrogenic DI Primary (Genetic) - X-linked recessive (V2-R defect) - Autosomal recessive (AQP2 defect) - Autosomal dominant (AQP2 defect) Secondary o Idiopathic o Chronic renal disease - Polycystic kidneys - Obstructive uropathy o Metabolic disease - Hypercalcemia - Hypokalemia o Drug induced - Lithium - Demeclocyclin o Osmotic diuretics - Glucose - Mannitol o Systemic disorders - Amyloidosis - Myelomatosis Causes of Hypothalamic Diabetes Insipidus • Hypophysectomy • surgery to remove suprasellar tumors • Idiopathic • Familial • Histiocytosis • Infections • Autoimmune • Acquired Rare: o Tumor (pituitary macroadenoma, craniopharyngioma, metastatic carcinoma) o Granulomata (sarcoid, eosinophilic granuloma) o Infection (pyogenic or tuberculous basal meningitis, encephalitis) o Vascular Prepartum Hypotension o Aneurysm o External Irradaiation Types of DI Types: • Central, Neurogenic or Pituitary DI (hypothalamic) • Nephrogenic DI Genetic (congenital) Acquired Drugs • Primary DI Gestat Continue reading >>

Diabetes Insipidus: Causes & Symptoms + 5 Natural Treatments

Diabetes Insipidus: Causes & Symptoms + 5 Natural Treatments

Diabetes insipidus, is a debilitating and rare disease, with a prevalence of 1 out of 25,000 people. Often referred to as “water diabetes,” it is a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. It’s caused by a defect in the pituitary gland or in the kidneys. (1) The term insipidus means “without taste” in Latin, while diabetes mellitus involves the excretion of “sweet” urine. People with diabetes insipidus pass urine that is diluted, odorless and relatively low in sodium content. Diabetes insipidus and diabetes mellitus (which includes both type 1 and type 2 diabetes) are unrelated. Both conditions do cause frequent urination and constant thirst. People with diabetes insipidus have normal blood sugar levels, but their kidneys cannot balance fluid in the body. Although the symptoms of diabetes insipidus can be bothersome and sometimes even life-changing, the condition doesn’t increase future health risks when it is managed properly. It’s important to find the right treatment plan, which typically involves taking measures to avoid dehydration. What is Diabetes Insipidus? Diabetes insipidus is a condition that disrupts normal life due to increased thirst and passing of large volumes or urine, even at night. It is a part of a group of hereditary or acquired polyuria (when large amounts of urine is produced) and polydipsia (excessive thirst) diseases. It’s associated with inadequate vasopressin or antidiuretic hormone secretion. Vasopressin, which includes arginine vasopressin (AVP) and antidiuretic hormone (ADH), is a peptide hormone formed in the hypothalamus. It then travels to the posterior pituitary where it releases into the blood. In order to fully understand the cause of diabetes ins Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Types of diabetes insipidus Diabetes insipidus can be divided into four different types that are caused by any one of four fundamentally different defects (Fig. 5.1): 1. pituitary, central, neurogenic, or neurohypophyseal diabetes insipidus, the most common type, results from a deficiency in the production of the antidiuretic hormone arginine vasopressin (AVP); 2. renal or nephrogenic diabetes insipidus is caused by renal insensitivity to the antidiuretic effects of AVP, for example, due to impairment of the renal vasopressin V2 receptor or aquaporin-2 water channel; 3. primary polydipsia is due to suppression of AVP secretion as a result of excessive fluid intake. Depending on whether the excessive fluid intake is due to abnormal thirst or due to a psychological disorder, primary polydipsia is subdivided into, respectively, dipsogenic diabetes insipidus11,12 psychogenic diabetes insipidus,13,14 and 4. gestational diabetes insipidus,15–18 which is primarily due to increased metabolism of AVP by circulating vassopressinase produced by the placenta in the pregnant woman but may also involve renal resistance and/or subclinical deficiency in AVP production. Complete diabetes insipidus is defined by persistently low urine osmolality (<300 mosmol/kg) during a fluid deprivation test providing plasma osmolality rises above 295 mosmol/kg. Partial diabetes insipidus is defined by a subnormal increase in urine osmolality (300–600 mosmol/kg) during a fluid deprivation test with the same rise in plasma osmolality.4 Definition Diabetes insipidus (DI) is a heterogeneous condition characterized by polyuria and polydipsia caused either due to a lack of secretion of vasopressin (antidiuretic hormone) from posterior pituitary, its physiological suppression following excessive water in Continue reading >>

Central Diabetes Insipidus

Central Diabetes Insipidus

12 Endocrinology Diabetes insipidus REF: Manual of Endocrinology and Metabolism - Norman Lavin, M.D. 1994 A. Definition Diabetes insipidus (DI) is the excretion of a large amount of dilute urine (hypotonic polyuria). To qualify for this diagnosis the urinary volume should be more than 30 ml/kg/day, the urine osmolality less than 300 mOsm/kg, and the specific gravity less than 1.010. B. Etiology Hypotonic polyuria could result from any of three different defects: Inadequate secretion of AVP, which is known as central, or neurogenic, DI. Impaired renal responsiveness to AVP, which is known as nephrogenic DI. Increased water intake or primary polydipsia, also known as dipsogenic DI. C. Central diabetes insipidus Definition: Central DI is a polyuric syndrome that results from a lack of sufficient AVP to concentrate the urine. It is characterized by the following symptoms: Inappropriately dilute urine in the presence of strong osmotic or nonosmotic stimuli for AVP secretion The absence of intrinsic renal disease A rise in urine osmolality following the administration of AVP Etiology: The main causes of central DI are summarized in Table 7-1 Table 7-1. Central DI is either familial or acquired. The familial disease is inherited as an autosomal dominant trait; it shows variable expression among affected individuals, and all patients respond to exogenous AVP administration. The acquired form of central DI may result from any disease affecting the hypothalamus-posterior pituitary region such as trauma, neoplastic disease, ischemia, granulomatous or infiltrative disease, infections, and autoimmune disease. Some of the cases are idiopathic. Anterior pituitary diseases or tumors rarely cause DI. Pathophysiology: Polyuria does not occur until AVP secretion becomes insufficient to ma Continue reading >>

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