Diabetes insipidus is a hormonal disorder characterized by a deficiency of antidiuretic hormone (ADH). ADH is responsible for regulating the body’s water balance. An ADH deficiency causes the kidneys to excrete too much water. Ultimately, diabetes insipidus leads to electrolyte imbalances and dehydration.
Here you will find further information as well as a selection of specialists and centers for diabetes insipidus.
Definition: What is diabetes insipidus?
ADH is produced in the pituitary gland and travels through the bloodstream to the kidneys, where it regulates water balance. If ADH is absent or present in insufficient concentrations, kidney function is impaired and too much water is excreted.
As a result, the body loses up to 25 liters of fluid per day. This disrupts electrolyte balance and leads to dehydration.
There are two types of diabetes insipidus:
- central diabetes insipidus—the pituitary gland produces no ADH or too little ADH
- renal diabetes insipidus – ADH is produced in the pituitary gland but does not act on the kidneys
Causes of diabetes insipidus
It is not always possible to determine the cause of diabetes insipidus. In about one-third of cases, the cause remains unknown.
The condition is often caused by damage to the pituitary gland or its higher-level control center in the brain. This can be due to
- tumors,
- mechanical injuries (e.g., from an accident), or
- inflammation
can lead to a failure in ADH production and, consequently, to central diabetes insipidus. This damage can result from tumors, mechanical injury (e.g., due to an accident), or inflammation.
Nephrogenic diabetes insipidus results
- due to a congenital genetic defect on the X chromosome or
- following kidney damage, for example due to poisoning, inflammation, or an adverse drug reaction.
Diabetes insipidus causes the kidneys to excrete too much water © peterschreiber.media | AdobeStock
Symptoms of diabetes insipidus
Typical signs of diabetes insipidus, whether central or renal, include extremely increased urine output and fluid intake.
In addition, frequent nighttime trips to the bathroom can lead to sleep disturbances and daytime fatigue.
Diagnosis of diabetes insipidus
Diabetes insipidus can essentially be diagnosed using two test procedures: the thirst test and the saline infusion test.
In the so-called thirst test, patients are not allowed to consume any fluids for 12 hours. Blood and urine samples are analyzed at regular intervals. During this “thirst period,” the ADH level in the blood increases in healthy individuals, while the electrolyte concentration in the blood remains constant. In the urine, the concentration of electrolytes increases because water excretion is reduced.
In contrast, in diabetes insipidus, the concentration of electrolytes in the urine would remain low, while it rises in the blood.
A saline infusion test can also provide information about diabetes insipidus. In this test, the patient is administered a highly concentrated saline solution, and the electrolyte concentrations in the blood and urine are then measured.
To rule out a tumor as the cause of ADH deficiency, the relevant area of the brain can be visualized using magnetic resonance imaging (MRI).
Treating Diabetes Insipidus
Central diabetes insipidus can be treated by addressing the underlying cause of the ADH deficiency. This allows normal ADH production to resume.
If the cause is unknown, desmopressin can be administered. This medication mimics the effect of ADH in the body, thereby restoring proper kidney function.
Renal diabetes insipidus is more difficult to treat. It is possible to reduce the volume of blood in the body using diuretics (thiazide diuretics). This causes the kidneys to filter out more salts and water, which can temporarily regulate electrolyte balance.
However, this treatment is unsuitable for patients with kidney impairment and older patients. Other treatment options are therefore being tested.
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