Diabetes insipidus is an uncommon endocrine disorder characterized by an inability to concentrate urine. As a result, it is distinguished by a huge volume of very dilute urine, ranging from 7 to 8 liters per day, at times 12 liters per day. It is characterized by an imperious thirst, causing the affected individual to consume as much fluids as they generate pee.
This persistent thirst happens at all hours of the day and night, disrupting sleep and social life. When access to water is problematic this thirst causes worry. Diabetes insipidus is classified into two categories. The first is Central Diabetes Insipidus (CDI), which is caused by a lack of antidiuretic hormone (ADH) or arginine vasopressin (AV) .
This hormone is produced in the rear of the pituitary gland, which is positioned behind the eyes at the base of the brain. The second condition, nephrogenic diabetes insipidus (NDI) is caused by the kidneys’ failure to respond to the effects of anti-diuretic hormone, which is generated in normal amounts.
What Other Disease Causes High Water Intake?
Potomania is a psychological disease that involves excessive drinking in people who do not have an illness of the posterior pituitary or kidney.
This condition usually develops gradually, and excessive drinking naturally results in a frequent desire to urinate. The need for purity is sometimes triggered in these patients. At most, this condition can result in water intoxication as well as neurological issues.
What Is The Distinction Between Diabetes Mellitus And Diabetes Insipidus?
The only thing that diabetes mellitus and diabetes insipidus have in common is the nomenclature. Diabetes is derived from the Greek term diabetes, which means”to pass through.” It discusses the connection between a persistent thirst and the need to urinate.
This is known as “polyuria-polydipsia.” In the case of diabetes mellitus, the urine contains a lot of sugar. The urine in diabetes insipidus is exceedingly dilute, and as a result tasteless. While the symptoms of these disorders are similar (high urine output and thirst), the causes and therapies are not.
What Are The Causes?
In central diabetes insipidus, inadequate antidiuretic hormone (ADH) production can be caused by a variety of reasons, including:
- Tumors in the posterior pituitary
- Skull base fractures
- Inflammation of the pituitary gland
- Pituitary gland after surgery
- Certain diseases (e.g., sarcoidosis) or following tuberculosis
Diabetes insipidus is a genetic condition that can be solitary or coupled with insulin-dependent diabetes and bilateral optic atrophy (Wolfram syndrome).
The ADH level is normal in nephrogenic diabetes insipidus and the pituitary is unaffected, but the kidney is indifferent to ADH activity. Diabetes is caused by a variety of factors, some of which are hereditary and manifest themselves as early as infancy, even at birth, while others are connected to kidney illness or drug usage.
In about 40% of cases no cause is found, so we speak of idiopathic diabetes insipidus.
What Happens In The Absence of ADH?
Normally, ADH permits the kidney collecting duct to reabsorb water, reducing water loss, and as a result the volume of urine that concentrates in toxins. This hormone’s release is controlled by the concentration of ions and particles in the blood. If this concentration is high, the hypothalamus, a central nervous system structure related to the posterior pituitary sends it a neurological message.
This gland subsequently secretes ADH into the blood, which lowers water loss in the kidneys. In the absence of ADH, the kidney no longer stores water, and urine volume can reach up to 12 liters in the event of complete ADH deficiency. The individual with diabetes insipidus compensates for water loss with similar intakes, but he is at danger of dehydration if he does not drink enough.
The kidneys are no longer susceptible to ADH activity in nephrogenic diabetes insipidus.
How Does Someone Suffering From Diabetes Insipidus Feel?
Polydipsia occurs when a person with diabetes insipidus, regardless of type is in good general health yet has a constant sense of thirst. This thirst is so voracious that it needs regular drinking, even at night, which interferes with sleep. This thirst is caused by an insatiable desire to urinate. The urine, which is plentiful is as dilute and pale as water.
Dehydration, which happens when a person is unable to consume enough fluids can result in loss of consciousness or even a coma. Weight loss and headaches, as well as overall weakness and hypothermia might accompany these two key symptoms.
What Are The Mandatory Tests For This Disease?
When the attending physician suspects diabetes insipidus, he orders a fluid restriction test. It is used in hospitals to swiftly treat potential dehydration by preventing the patient from consuming water for at least eight hours. It is a matter of determining whether or not the suppression of beverages allows for the concentration of urine.
This test distinguishes diabetes insipidus from potomania, a mental condition characterized by excessive drinking but no problems in hormone production. When abnormally low or even non-existent ADH production is observed, MRI (Magnetic Resonance Imaging) can be utilized to determine the cause. This is done to show the existence of a tumor or a fracture.
What Are The Diabetic Insipidus Treatments?
Hormone replacement treatment for central diabetes insipidus includes administering a synthetic hormone to the body in lieu of the missing natural hormone. In the case of temporary diabetes insipidus (after pituitary surgery or during pregnancy) the therapy lasts the duration of the insufficiency, but in most cases it is administered for life.
There is just one molecule available: desmopressin, often known as DDAVP (Minirin), which works on the natural renal antidiuretic hormone receptor. It is available in several forms, including tablets, nasal solution, nasal spray, and injectable solution. Hormone replacement treatment has little impact on nephrogenic diabetic insipidus.
This will mostly entail treating the renal disease or discontinuing the medicine that is causing the urine concentration deficit. In the case of a hereditary condition, the medications seek to alleviate symptoms and prevent dehydration.
Which Specialist Is Involved?
In general, the attending physician is the first to be called when there is discomfort resulting in a constant urge to drink, as well as sleep difficulties caused by frequent urine.
The patient will then be referred to an endocrinologist, a neurologist in the event of suspected organ damage, or a psychiatrist in the case of suspected potomania based on information from the interview, the clinical examination, the medication taken, and the results of the biological and radiological analysis.
How To Gain Relief?
In the case of a deficiency of ADH hormone, hormone replacement treatment is delivered by taking a medicine on a regular basis that inhibits urine output, allowing the patient to no longer be chronically thirsty and wanting to urinate.
Treating the kidney condition or discontinuing specific drugs are approaches that can help manage nephrogenic diabetic insipidus. A healthy lifestyle is also ideal with a distribution of fluid consumption during the day, and a reduction after supper.