DIABETES INSIPIDUS

In healthy individuals, when the bodily fluids are depleted, ADH is released from the pituitary
gland which prevents the excretion of fluids from the body in the form of urine. ADH acts on the
kidneys to increase water permeability in the collecting duct and distal convoluted tubule.
Specifically, ADH acts on transmembrane protein channels called aquaporins that open up to
allow water into the collecting duct. Once the permeability rises, the water is re-absorbed into
the blood, reducing urine volume and increasing its concentration.
Diabetes insipidus is caused by abnormality in the functioning or levels of antidiuretic hormone
(ADH), also known of as vasopressin. Manufactured in the hypothalamus and stored in the
pituitary gland, ADH helps to regulate the amount of fluid in the body.
Diabetes insipidus is a rare disorder that causes the body to make too much urine. . People with this disorder need
to urinate frequently, called polyuria. They may also feel thirsty all the time and drink lots of liquids, a condition
called polydipsia.

Diabetes insipidus is caused by problems with a chemical called vasopressin

(AVP), which is also known as antidiuretic hormone (ADH).

AVP is produced by the hypothalamus and stored in the pituitary gland until needed.

The hypothalamus is an area of the brain that controls mood and appetite.

The pituitary gland is located below your brain, behind the bridge of your nose.

AVP regulates the level of water in your body by controlling the amount of urine your
kidneys produce.

When the level of water in your body decreases, your pituitary gland releases AVP to
conserve water and stop the production of urine.

In diabetes insipidus, AVP fails to properly regulate your body's level of water, and
allows too much urine to be produced and passed from your body.

There are 2 main types of diabetes insipidus:

 cranial diabetes insipidus – where the body does not produce enough AVP, so
excessive amounts of water are lost in large amounts of urine
 nephrogenic diabetes insipidus – where AVP is produced at the right levels, but,
for a variety of reasons, the kidneys do not respond to it in the normal way

Who is more likely to have diabetes insipidus?

People of all ages can develop diabetes insipidus. You are more likely to develop the condition if you 1,2
  have a family history of diabetes insipidus
 had brain surgery or a major head injury
 take medicines that can cause kidney problems, including some bipolar disorder   medicines and diuretics
NIH external link

 have metabolic disorders (high blood calcium or low blood potassium levels)

What causes diabetes insipidus?

Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount
of fluid in your body. Problems with a part of your brain that controls thirst can also cause diabetes insipidus. Specific causes
vary among the four types of diabetes insipidus: central, nephrogenic, dipsogenic, and gestational. 2

Central diabetes insipidus

In central diabetes insipidus, your body doesn’t make enough vasopressin, also called “antidiuretic hormone.” Vasopressin is
produced in your hypothalamus, a small area of your brain near the pituitary gland. When the amount of fluids in your body falls
too low, the pituitary gland releases vasopressin into your bloodstream. The hormone signals your kidneys to conserve fluids by
pulling fluids from your urine and returning fluid to your bloodstream. But if your body can’t make enough vasopressin, the fluid
may get flushed out in your urine instead.

Causes of central diabetes insipidus include

 damage to your hypothalamus or your pituitary gland from surgery, infection, inflammation, a tumor, or a head
injury
 an autoimmune disorder
 an inherited gene mutation
Nephrogenic diabetes insipidus

In nephrogenic diabetes insipidus, your body makes enough vasopressin but your kidneys don’t respond to the hormone as they
should. As a result, too much fluid gets flushed out in your urine. Causes include

 some medicines, especially those used to treat bipolar disorder NIH external link

 low levels of potassium in your blood

 high levels of calcium in your blood
 a blocked urinary tract
 an inherited gene mutation
 chronic kidney disease, though rarely

Nephrogenic diabetes insipidus can be present at birth (congenital) or

develop later in life as a result of an external factor (acquired).
Dipsogenic diabetes insipidus

In this type of diabetes insipidus, a problem with your hypothalamus causes you to feel thirsty and drink more liquids. As a
result, you may need to urinate often. Causes include

 damage to your hypothalamus from surgery, infection, inflammation, a tumor, or a head injury
 some medicines or mental health problems
Gestational diabetes insipidus

Gestational diabetes insipidus is a rare, temporary condition that can develop during pregnancy. This type of diabetes insipidus
occurs when the mother’s placenta   makes too much of an enzyme that breaks down her vasopressin. Women who are pregnant
NIH external link

with more than one baby are more likely to develop the condition because they have more placental tissue. 3 Because the liver
plays a role in curbing the enzyme that breaks down vasopressin, diseases and conditions that affect liver function also increase
risk. Examples include preeclampsia   and HELLP syndrome  .
NIH external link NIH external link