Diabetes insipidus is the deficiency or difficulty in the action of the antidiuretic hormone (ADH), which controls the speed at which urine is produced, causing symptoms such as extreme thirst, even if you have drunk water, and excessive urine production, which can cause dehydration.
This condition can be caused by changes in regions in the brain responsible for the production, storage and release of antidiuretic hormone, also called vasopressin, but it can also occur due to changes in the kidneys that stop responding to this hormone.
The treatment of diabetes insipidus is carried out by an endocrinologist, who may recommend controlling the amount of fluids ingested and the use of medication to alleviate symptoms.
Symptoms of diabetes insipidus
The main symptoms of diabetes insipidus are:
- Uncontrollable thirst;
- Production of large amounts of urine;
- Frequent need to get up to urinate during the night;
- Preference for drinking cold liquids.
In the case of adults, urine production is more than 3 liters per day, while in children it is 2 liters/m² per day.
Furthermore, over time, excessive fluid consumption causes worsening sensitivity to the hormone ADH or decreasing production of this hormone, which can worsen symptoms.
This disease can also occur in babies and children and because of excessive urine production it is important to be aware of the signs of diabetes insipidus such as constantly wet diapers or bedwetting, difficulty sleeping, fever, vomiting, constipation, growth retardation. and weight development or loss.
What is the difference between diabetes insipidus and mellitus?
Diabetes insipidus is different from diabetes mellitus, as the hormones that change in these two types of diabetes are different.
In diabetes insipidus, there is a change in the hormone ADH, which controls the amount of urine a person produces.
In diabetes mellitus, there is an increase in blood glucose levels due to low insulin production by the body or the body’s resistance to responding to insulin. Check out other types of diabetes.
How to confirm the diagnosis
The diagnosis of diabetes insipidus is made by an endocrinologist or pediatrician, through evaluation of symptoms, health history and laboratory tests.
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Therefore, the doctor must request a 24-hour urine volume test and blood tests to assess sodium and potassium levels, which may be altered. Find out how the 24-hour urine test is performed.
In addition, the doctor may order a fluid restriction test, in which the person remains hospitalized without drinking fluids and is monitored to check for signs of dehydration, the amount of urine produced and hormone levels.
Another test that your doctor may order is an MRI of the brain to evaluate changes in the brain that may be triggering the disease.
Possible causes
The causes of diabetes insipidus depend on the type of disease and can be classified as:
- Head trauma;
- Surgeries or infections in the brain, tumor or brain aneurysm;
- Autoimmune or genetic diseases;
- Obstruction of the blood vessels that supply the brain;
- Polycystic kidney disease or serious kidney infections;
- Changes in potassium levels in the blood;
- Diseases such as sickle cell anemia, multiple myeloma, amyloidosis, sarcoidosis;
- Post kidney transplant or kidney cancer.
Furthermore, the use of medications, such as lithium, rifampicin, gentamicin or exam contrasts, can also cause diabetes insipidus, by causing kidney changes.
Types of diabetes insipidus
The main types of diabetes insipidus are:
1. Diabetes insipidus central
Central diabetes insipidus is caused by changes in the region of the brain called the hypothalamus, which loses the ability to produce the hormone ADH, or in the pituitary gland responsible for storing and releasing ADH into the body.
When the levels of the hormone ADH are reduced, the kidneys are unable to control the production of urine, which starts to be formed in large quantities, which is why the person urinates a lot, which can reach more than 3 to 30 liters per day. .
This type of diabetes insipidus is usually caused by trauma, tumors, infections or brain surgery.
2. Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus occurs when the concentration of the hormone ADH in the blood is normal, but the kidneys do not respond normally to it.
This type of diabetes insipidus can be caused by kidney disease or genetic factors that are rarer and more serious, and appear from childhood.
3. Gestational diabetes insipidus
Gestational diabetes insipidus is a rare condition, but it can occur around the third trimester of pregnancy due to the production of an enzyme by the placenta, which destroys the woman’s ADH hormone, leading to the appearance of symptoms.
However, it is a disease that only occurs during pregnancy, normalizing around 4 to 6 weeks after birth.
4. Diabetes insipidus dipsogênico
Dipsogenic diabetes insipidus, also called primary polydipsia, can occur due to damage to the thirst regulation mechanism in the hypothalamus, leading to the appearance of the common symptoms of diabetes insipidus.
This type of diabetes can also be related to mental illnesses, such as schizophrenia, for example.
How the treatment is carried out
The treatment of diabetes insipidus must be carried out under the guidance of an endocrinologist or pediatrician and aims to reduce the amount of urine that the body produces and must be indicated by the doctor according to the cause of the disease.
The types of treatment depend on the severity of the disease and the type of diabetes insipidus, and can be done with:
1. Control fluid intake
In mild cases of central diabetes insipidus, the doctor may only recommend controlling the amount of fluids ingested, and it is recommended to drink at least 2.5 liters of fluids per day to avoid dehydration.
Central diabetes insipidus is considered mild if the person produces only 3 to 4 liters of urine in 24 hours.
2. Hormone replacement
In more severe cases of central diabetes insipidus or gestational diabetes insipidus, the doctor may recommend replacement of the ADH hormone, through the medication desmopressin or DDAVP, which can be administered by vein, orally or by inhalation.
Desmopressin is a hormone that is more potent and more resistant to degradation than the ADH naturally produced by the body and works exactly like natural ADH, preventing the kidneys from producing urine when the water level in the body is low.
3. Diuretics
Diuretics can be used, especially in severe cases of nephrogenic diabetes insipidus, and the diuretic most recommended by doctors is hydrochlorothiazide, which acts by reducing the rate of blood filtration by the kidneys, which reduces the amount of urine excreted by the body.
Additionally, your doctor should recommend a low-salt diet to help reduce the amount of urine your kidneys produce and drinking at least 2.5 liters of water per day to prevent dehydration.
In cases where nephrogenic diabetes insipidus has been caused by the use of certain medications, the doctor may recommend discontinuing their use and switching to another type of treatment.
4. Anti-inflammatories
Anti-inflammatories, such as ibuprofen, may be recommended by the doctor in cases of nephrogenic diabetes insipidus, as they help to reduce urine volume and should be used in combination with diuretics.
However, using anti-inflammatories for a long time can cause problems such as worsening kidney function and stomach irritation or the appearance of stomach ulcers.
To prevent these stomach problems, your doctor may recommend medicines such as omeprazole or esomeprazole, for example.
5. Psychiatric medications
In cases of dipsogenic diabetes insipidus caused by mental illness, treatment must be carried out by a psychiatrist with specific medications for each case.
6. Antibiotic
If diabetes insipidus was caused by an infection, for example, the doctor may start using antibiotics according to the type of infection, and this treatment is generally done before starting specific treatment for diabetes insipidus.
Possible complications
The complications that diabetes insipidus can cause are dehydration or imbalance of electrolytes in the body such as sodium, potassium, calcium and magnesium, due to the large loss of fluids and electrolytes by the body through urine, which can cause symptoms such as:
- Dry mouth;
- Headache;
- Dizziness;
- Confusion or irritability;
- Excessive tiredness;
- Muscle pain or cramps;
- Nausea or vomiting;
- Loss of appetite.
If you experience one of these symptoms, you should seek medical help immediately or the nearest emergency room.
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