Diabetes insipidus: how to spot it and what is the management?

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What is diabetes insipidus?

Diabetes insipidus is a rare endocrine disease which results in a regulatory problem in the kidneys, namely, an inability of the kidneys to concentrate urine. Concretely, this is characterized by polyuria (emission of abundant urine – which can range from 7 to 12 liters per day in the most extreme cases -) and polydipsia (increased thirst).

There are two types of diabetes insipidus:

  • central diabetes insipidus (CDI). It is due to a deficiency of the antidiuretic hormone or ADH, or arginine vasopressin (AVP). This hormone is synthesized at the back of the pituitary gland, a gland located at the base of the brain. It is in particular this endocrine gland which manages the water balance in the body, which acts as the messenger between the organs and which “informs” them when it is necessary to eliminate or retain water. It is the most common type of diabetes insipidus.
  • nephrogenic diabetes insipidus (DIN) is defined by the inability to concentrate urine as much as possible. The kidneys do not respond to the effects of the antidiuretic hormone, yet produced in normal quantities.

What are the causes of diabetes insipidus?

As explained previously, diabetes insipidus is caused by deficiency or insensitivity to vasopressin, the antidiuretic hormone. This deficiency can be idiopathic (the cause of which has not been attributed) as well as being the consequence of various injuries, cranial traumas, meningitis, encephalitis, aneurysms, thromboses, brain tumors or even an exceptional hereditary disease affecting the brain. kidney.

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Family history is also a significant risk factor.

What are the symptoms of diabetes insipidus?

Symptoms of diabetes insipidus may be insidious or appear suddenly. They can develop at any age.

As explained earlier, they manifest as increased thirst, leading the person to sometimes drink up to 10 liters of water per day and produce as much urine. This can cause significant suffering in social, professional or other sectors. Not to mention that this thirst can lead to sleep disorders, since the person in question is forced to wake up at night to drink or / and to urinate. Last but not least, this thirst can generate anxiety when access to water is difficult.

These major symptoms can be accompanied by weight loss, headaches, constipation, and hypothermia. In some cases, diabetes insipidus can be responsible for neurological sequelae.

How to diagnose diabetes insipidus?

To confirm or deny the diagnosis, a fluid restriction test will be prescribed to the patient. It consists in depriving the person concerned of drink for at least eight hours in order to be able to measure his production and the concentration of his urine (several times). This test thus makes it possible to rule out the track of potomania (psychiatric condition which leads to excessive drinking in people who have no kidney disease).

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Blood tests will also be prescribed and, depending on the case, other additional tests will be associated to look for the potential cause of this diabetes insipidus.

How to treat diabetes insipidus?

First, treating the cause is imperative if there is one.

Then, in the case of a lack of ADH hormone, the patient will be administered a hormonal treatment stimulating the production of this hormone. Among these treatments, desmospressin is the best known. If it is not a lack of ADH hormone but the kidneys are the cause of this pathology (nephrogenic diabetes insipidus), then kidney disease should be treated.

The healthy lifestyle and good hydration of the person concerned will also be scrutinized.

Can diabetes insipidus be prevented?

To date, there is no way to prevent diabetes insipidus. However, if in doubt, it is important to consult your doctor, renal damage (kidney malfunction) which may occur in the absence of treatment.

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