Diabetes Insipidus

Dr.M.Bastanta Tarigan,SpPD-KEMD
Diabetes Insipidus

• Producer hypotonic polyuria.

• Central diabetes Insipidus (CDI): Deficient secretion of arginine
vasopressin (AVP)
• Primary polydipsia results fron inhibition of AVP release due to excess
fluid intake.
• Nephrogenic diabetes Insipidus(NDI): Resistence to the action of this
hormone.
Diabetes Insipidus

Central Diabetes Insipidus Nephrogenic Diabetes Insi

pidus
Causa
Causa Head
Head trauma.
trauma. Neoplasma
Neoplasma pituitary,
pituitary, granulomatosus
granulomatosus Resistance to the action od AVP: Herediter is
disease(
disease( eg sarcoidosis,histiocytosis X).
eg sarcoidosis,histiocytosis X). caused by X-Linked transmission of deficient V2
Mutasi gen.
Mutasi gen. receptor for AVP and also an autosomal
Infection
Infection of
of the
the central
central nervous
nervous system,
system, Hypoxic
Hypoxic dominant defect in the aquaporin-2 gene.
encephalopathy.
encephalopathy. Drugs: Lithium, Antibiotic ( democlocycline), anti
CNS
CNS vascular
vascular accidents
accidents (( Sheehan
Sheehan syndrome)
syndrome) fungal, anti neoplastics.
Idiopathic.
Idiopathic. Electrolit: persistent hypercalcemia (11 mg/dL) ,
severe hypokalemia(
Pathophysiology of diabetes Insipidus
• AVP is produced in the supraoptic and paraventricular nuclei of the
hypothalamus. It travels down the pituitary stalk for storages in the
posterior pituitary.
• AVP decrease urine flow by increasing reabsorption of solute free water in
the distal and collecting tubulus od the kidney.
• APV binds to the tubular V2 receptors, leading to production of cyclic
adenosin monophosphate,which increase tubular permeability to water by
perforating the luminal surface with water channels made of aquaporin-2.
• Hypothalamic osmoreceptors and baroreceptors in the carotids,the atria
and aorta regulate the secretion of AVP
Diagnosis of diabetes Insipidus
Diagnosis of diabetes Insipidus
Etiology CDI ( Central Diabetes Nephrogenic Diabetes Primary polidipsia
Insipidus) Insipidus
Etiology
Etiology Trauma
Trauma Family
Family history
history History
History psychiatric
psychiatric
Serum
Serum sodium
sodium Normal
Normal or
or slightly
slightly elevated
elevated Normal
Normal or
or slightly
slightly Low
Low
elevated
elevated

Water Deprvation Oasmolalitas Osmolalitas normal. Osmolalitas

Water Deprvation
Testing(WDT) normal Osmolalitas normal.
Testing(WDT)
300mOsm normal
300mOsm
Treatment of diabetes Insipidus
Central Diabetes Insipidus (CDI)
Desmopressin (DDAVP): adalah modifikasi sintetis AVP.
DDAVP: tersedia dalam bentuk tablet, spray dan nasal
Dosis awal : 1 mg 2x1
Ada agent lain yang meningkatkan sekresi AVP yaitu
CPZ, Indapamide, Carbamazepine)
Nephrogenic Diabetes Insipidus(NDI)
Desmopressin kurang poten karena penyebab NDI
adalah resistensi AVP.
Diuretik tiazid menurunkan volume urin . Tiazid
meningkatkan reasorpsi sodium dan air sehingga
menurunkan aliran air di tubulus collecting dimana
tempat tersebut adalah lokasi AVP bekerja.
NDSAD menurunkan prostaglandin renal sehingga
meningkatkan kerja AVP dan menurunkan volume urin
di NDI
TERIMA KASIH