PATHOPHYSIOLOGY OF DIABETES INSIPIDUS

Neurogenic Diabetes
Insipidus Nephrogenic Diabetes
Insipidus

Predisposing Factors Predisposing Factors Precipitating Factors

Precipitating Factors
Pituitary hypogenesis Male Sickle cell disease
Trauma to pituitary stalk
   •    AVP-neurophysin Genetic- mutation in the Drugs such as demeclocyline, lithium,
Hypothalamic/ Pituitary AVPR2 gene, encoding aminoglycosides
   •    Wolfram syndrome the renal vasopressin V2
Surgery
receptor Pyelonephritis
Tumors, Ischemia, Viral X-linked recessive
Electrolyte imbalance
encephalitis and meningitis

Renal insensitivity to the effect of vasopressin

Deficient or absent excretion of ADH

Dx: Serum ADH

V1 and V2 receptors in the kidneys are not stimulated

No activation of adenyl cyclase and cyclic AMP (second

messenger)

Aquapourin 2, which is a water Aquaporins 3 & 4 is the water channels

channel membrane protein that located in the basolateral membrane not
responds through the action of altered by ADH. Water reabsorption is
cAMP is deactivated. not altered there

Collecting tubules fail to increase

Water reabsorption does not occur in the luminal membrane water permeability
 Dx: Water Deprivation
Test
Excretion of an increased Decreased body Rise in plasma osmolality
Desmopressin volume of dilute urine water Thiazide
diuretics

Indomethacin
Decreased urine Thirst mechanism is stimulated
specific gravity

Increase in water uptake Polydipsia

Osmolality of body fluid stabilizes at a new higher level that approximates the
osmotic threshold for thirst

Serum Na
Hypernatremia Dehydration

Fatigue Polyuria

Hypotension Dry Mucus Membranes

References: http://books.google.com.ph/books?id=VQSSnC-
csvoC&pg=PT87&dq=central+diabetes+insipidus http://books.google.com.ph/books?
id=aRIh19rGY7QC&pg=PT521&dq=neurogenic+diabetes+insipidus+PATHOPHYSIOLOGY

http://books.google.com.ph/books?
id=6gezJTHaAVMC&pg=PA44&dq=neurogenic+diabetes+insipidus+pathophysiology

http://www.mdconsult.com/books/