Diabetes insipidus causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diabetes insipidus is caused by a variety of factors. The causes for each sub type of diabetes insipidus is classically different. It is important to identify these underlying causes of the various forms in order to appropriately diagnose and treat each type.
Causes
Central DI
CDI is caused by the destruction or degeneration of neurons originating in the supraoptic and paraventricular nuclei. Central DI, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. The most common cause of central diabetes insipidus (CDI), accounting for the vast majority of cases, are idiopathic diabetes insipidus (DI)[1][2]. Others include[2];
- Familial and congenital disease
- Familial CDI[3]
- Wolfram syndrome also known as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness)[4]
- Congenital hypopituitarism[5]
- Septo-optic dysplasia[6]
- Neurosurgery or trauma[7][8]
- Cancer[1]
- Hypoxic encephalopathy
- Infiltrative disorders[9][10]
- Post-supraventricular tachycardia[11]
- Anorexia nervosa[12]
Nephrogenic DI
The most common causes of ADH resistance severe enough to produce polyuria are hereditary nephrogenic DI in children, and chronic lithium ingestion and hypercalcemia in adults. Acquired causes are often partially reversible with cessation of the offending drug or correction of hypercalcemia. Other causes include;
- Hereditary nephrogenic diabetes Insipidus[13]
- Vasopressin V2 receptor gene mutations[14][15]
- Aquaporin-2 gene mutation[16]
- Lithium toxicity[17]
- Hypercalcemia[18]
- Hypokalemia[19] Persistent severe hypokalemia (plasma potassium concentration usually below 3 meq/L) can impair urinary concentrating ability
- Other — Nephrogenic DI has been described in a number of other clinical settings
- Renal disease
- Drugs[22]
- Pregnancy[23]
- Bardet-Biedl syndrome[24]
- Bartter syndrome[25]
Psychogenic DI
Psychogenic DI also known as dipsogenic DI or primary polydipsia or factitious diabetes insipidus is characterized by a primary increase in water intake. Some of the major causes are:
- Psychiatric illnesses
- Use of phenothiazine which can lead to the sensation of a dry mouth
- Hypothalamic lesions that directly affect the thirst center
- Infiltrative disease such as sarcoidosis
Gestational DI
Gestational diabetes insipidus is a very rare complication of pregnancy. However, undiagnosed and untreated may lead to serious complications in both mother and fetus. The only cause that has been associated with this disorder is pregnancy. However, it is usually cause mild polyuria, which can be treated with desmopressin but if left untreated, it can progress to more severe complications.
Causes by Organ System
| Cardiovascular | Hypovolemic shock |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Amphotericin B, Demeclocycline, Lithium , Radiation - for CNS and nasopharyngeal malignancies , Pituitary radiation , Netilmicin , Kanamycin, Carbamazepine , Amikacin |
| Ear Nose Throat | No underlying causes |
| Endocrine | Ischemia of the pitutary gland , Sheehan syndrome , Pituitary tumour , Panhypopituitarism , lymphocytic hypophysitis , Familial hypopituitarism , congenital nephrogenic , Congenital hypopituitarism , Apoplexy , pituitary cysts |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | Inherited genetic kidney disorders , Genetic diseases - pit-1 mutation |
| Hematologic | Sickle cell disease , Langerhans cell histiocytosis |
| Iatrogenic | Neurosurgery , Pituitary surgery |
| Infectious Disease | Tuberculous meningitis , Meningoencephalitis , Infections |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | Dipsogenic diabetes insipidus , Ischemic encephalopathy , Subarachnoid hemorrhage , Mass lesions hypothalamus , Ischemic stroke , Intracranial space-occupying lesion , Intracranial bleeding , Hypoxic encephalopathy , Hypothalamic radiation , Brain aneurysm |
| Nutritional / Metabolic | Hypercalcemia , hemochromatosis , Anorexia nervosa |
| Obstetric/Gynecologic | Gestational diabetes insipidus |
| Oncologic | Pituitary Cancer , pituitary adenomas , malignant tumors infilterating hypothalamus from lung and breast , Histiocytosis , Craniopharyngioma |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | Polycystic kidney disease, Renal failure , Interstitial nephritis , Hypokalaemia , Hypercalcaemia |
| Rheum / Immune / Allergy | Sarcoidosis , Autoimmune Hypophysitis , Autoimmune Diabetes Insipidus |
| Sexual | No underlying causes |
| Trauma | Head injury , Trauma - fracture of skull base |
| Urologic | Partial blockage of the ureters |
| Dental | No underlying causes |
| Miscellaneous | Dehydration , Wolfram syndrome , Sicca syndrome , Septo-optic dysplasia , Infiltrative lesions , Idiopathic , Hand-Schuller-Christian Syndrome , Familial CDI , Erdheim-Chester disease , DIDMOAD syndrome , Anophthalmia -- hypyothalamo-pituitary insufficiency , Anophthalmia -- hypothalamo-pituitary insufficiency , Amyloidosis |
Causes in Alphabetical Order
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References
- ↑ 1.0 1.1 Kimmel DW, O'Neill BP (1983). "Systemic cancer presenting as diabetes insipidus. Clinical and radiographic features of 11 patients with a review of metastatic-induced diabetes insipidus". Cancer. 52 (12): 2355–8. PMID 6640507.
- ↑ 2.0 2.1 Maghnie M, Cosi G, Genovese E, Manca-Bitti ML, Cohen A, Zecca S; et al. (2000). "Central diabetes insipidus in children and young adults". N Engl J Med. 343 (14): 998–1007. doi:10.1056/NEJM200010053431403. PMID 11018166.
- ↑ Burbach JP, Luckman SM, Murphy D, Gainer H (2001). "Gene regulation in the magnocellular hypothalamo-neurohypophysial system". Physiol Rev. 81 (3): 1197–267. PMID 11427695.
- ↑ Bischoff AN, Reiersen AM, Buttlaire A, Al-Lozi A, Doty T, Marshall BA; et al. (2015). "Selective cognitive and psychiatric manifestations in Wolfram Syndrome". Orphanet J Rare Dis. 10: 66. doi:10.1186/s13023-015-0282-1. PMC 4450481. PMID 26025012.
- ↑ Yagi H, Nagashima K, Miyake H, Tamai S, Onigata K, Yutani S; et al. (1994). "Familial congenital hypopituitarism with central diabetes insipidus". J Clin Endocrinol Metab. 78 (4): 884–9. doi:10.1210/jcem.78.4.8157716. PMID 8157716.
- ↑ Hoyt WF, Kaplan SL, Grumbach MM, Glaser JS (1970). "Septo-optic dysplasia and pituitary dwarfism". Lancet. 1 (7652): 893–4. PMID 4191531.
- ↑ Seckl J, Dunger D (1989). "Postoperative diabetes insipidus". BMJ. 298 (6665): 2–3. PMC 1835326. PMID 2492841.
- ↑ Nemergut EC, Zuo Z, Jane JA, Laws ER (2005). "Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients". J Neurosurg. 103 (3): 448–54. doi:10.3171/jns.2005.103.3.0448. PMID 16235676.
- ↑ Grois N, Fahrner B, Arceci RJ, Henter JI, McClain K, Lassmann H; et al. (2010). "Central nervous system disease in Langerhans cell histiocytosis". J Pediatr. 156 (6): 873–81, 881.e1. doi:10.1016/j.jpeds.2010.03.001. PMID 20434166.
- ↑ Dunger DB, Broadbent V, Yeoman E, Seckl JR, Lightman SL, Grant DB; et al. (1989). "The frequency and natural history of diabetes insipidus in children with Langerhans-cell histiocytosis". N Engl J Med. 321 (17): 1157–62. doi:10.1056/NEJM198910263211704. PMID 2797079.
- ↑ Canepa-Anson R, Williams M, Marshall J, Mitsuoka T, Lightman S, Sutton R (1984). "Mechanism of polyuria and natriuresis in atrioventricular nodal tachycardia". Br Med J (Clin Res Ed). 289 (6449): 866–8. PMC 1443391. PMID 6434116.
- ↑ Gold PW, Kaye W, Robertson GL, Ebert M (1983). "Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa". N Engl J Med. 308 (19): 1117–23. doi:10.1056/NEJM198305123081902. PMID 6835335.
- ↑ van Lieburg AF, Knoers NV, Monnens LA (1999). "Clinical presentation and follow-up of 30 patients with congenital nephrogenic diabetes insipidus". J Am Soc Nephrol. 10 (9): 1958–64. PMID 10477148.
- ↑ Sasaki S (2004). "Nephrogenic diabetes insipidus: update of genetic and clinical aspects". Nephrol Dial Transplant. 19 (6): 1351–3. doi:10.1093/ndt/gfh172. PMID 15004257.
- ↑ Nomura Y, Onigata K, Nagashima T, Yutani S, Mochizuki H, Nagashima K; et al. (1997). "Detection of skewed X-inactivation in two female carriers of vasopressin type 2 receptor gene mutation". J Clin Endocrinol Metab. 82 (10): 3434–7. doi:10.1210/jcem.82.10.4312. PMID 9329382.
- ↑ Devonald MA, Karet FE (2004). "Renal epithelial traffic jams and one-way streets". J Am Soc Nephrol. 15 (6): 1370–81. PMID 15153548.
- ↑ Grünfeld JP, Rossier BC (2009). "Lithium nephrotoxicity revisited". Nat Rev Nephrol. 5 (5): 270–6. doi:10.1038/nrneph.2009.43. PMID 19384328.
- ↑ Berl T (1987). "The cAMP system in vasopressin-sensitive nephron segments of the vitamin D-treated rat". Kidney Int. 31 (5): 1065–71. PMID 3037155.
- ↑ Khositseth S, Uawithya P, Somparn P, Charngkaew K, Thippamom N, Hoffert JD; et al. (2015). "Autophagic degradation of aquaporin-2 is an early event in hypokalemia-induced nephrogenic diabetes insipidus". Sci Rep. 5: 18311. doi:10.1038/srep18311. PMC 4682130. PMID 26674602.
- ↑ CARONE FA, EPSTEIN FH (1960). "Nephrogenic diabetes insipidus caused by amyloid disease. Evidence in man of the role of the collecting ducts in concentrating urine". Am J Med. 29: 539–44. PMID 13807843.
- ↑ SHEARN MA, TU WH (1965). "NEPHROGENIC DIABETIC INSIPIDUS AND OTHER DEFECTS OF RENAL TUBULAR FUNCTION IN SJOERGREN'S SYNDROME". Am J Med. 39: 312–8. PMID 14320699.
- ↑ Garofeanu CG, Weir M, Rosas-Arellano MP, Henson G, Garg AX, Clark WF (2005). "Causes of reversible nephrogenic diabetes insipidus: a systematic review". Am J Kidney Dis. 45 (4): 626–37. PMID 15806465.
- ↑ Brewster UC, Hayslett JP (2005). "Diabetes insipidus in the third trimester of pregnancy". Obstet Gynecol. 105 (5 Pt 2): 1173–6. doi:10.1097/01.AOG.0000161811.02155.68. PMID 15863571.
- ↑ Anadoliiska A, Roussinov D (1993). "Clinical aspects of renal involvement in Bardet-Biedl syndrome". Int Urol Nephrol. 25 (5): 509–14. PMID 8270381.
- ↑ Peters M, Jeck N, Reinalter S, Leonhardt A, Tönshoff B, Klaus G Gü; et al. (2002). "Clinical presentation of genetically defined patients with hypokalemic salt-losing tubulopathies". Am J Med. 112 (3): 183–90. PMID 11893344.