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Causes
By Mayo Clinic staff
Diabetes insipidus occurs when your body can't regulate how it handles fluids. Normally, your kidneys remove excess body fluids from your bloodstream. This fluid waste is temporarily stored in your bladder as urine, before you urinate. When your fluid regulation system is working properly, your kidneys make less urine when your body water is decreased, such as through perspiration, to conserve fluid.
The volume and composition of your body fluids remain balanced through a combination of oral intake and excretion by the kidneys. The rate of fluid intake is largely governed by thirst, although your habits can increase your intake far above the amount necessary. The rate of fluid excreted by your kidneys is greatly influenced by the production of anti-diuretic hormone (ADH), also called vasopressin.
Your body makes ADH in the hypothalamus and stores the hormone in your pituitary gland, a small gland located in the base of your brain. ADH is released into your bloodstream when necessary. ADH then concentrates the urine by triggering the kidney tubules to reabsorb water back into your bloodstream rather than excreting as much water into your urine.
The way in which your system is disrupted determines which form of diabetes insipidus you have:
- Central diabetes insipidus. The cause of central diabetes insipidus is usually damage to the pituitary gland or hypothalamus, most commonly due to surgery, a tumor, an illness (such as meningitis), inflammation or a head injury. In some cases the cause is unknown. This damage disrupts the normal production, storage and release of ADH.
- Nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus occurs when there's a defect in the kidneys tubules — the structures in your kidneys that cause water to be excreted or reabsorbed. This defect makes your kidneys unable to properly respond to ADH. The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium and tetracycline, also can cause nephrogenic DI.
- Gestational diabetes insipidus. Gestational diabetes insipidus occurs only during pregnancy and when an enzyme made by the placenta — the system of blood vessels and other tissue that allows the exchange of nutrients and waste products between a mother and her baby — destroys ADH in the mother.
- Dipsogenic diabetes insipidus. In this form of DI, also known as primary polydipsia or psychogenic polydipsia, excessive fluid intake leads to suppression of ADH. Drinking too much liquid can be the result of abnormal thirst caused by damage to the thirst-regulating mechanism, situated in the hypothalamus. Diseases such as sarcoidosis can cause such damage. Dipsogenic DI also can be caused by mental illness.
In some cases of diabetes insipidus, doctors never determine a cause.
- What is diabetes insipidus? Diabetes Insipidus Foundation. http://www.diabetesinsipidus.org. Accessed June 18, 2010.
- Diabetes insipidus. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/insipidus. Accessed June 18, 2020.
- Bichet DG. Diagnosis of polyuria and diabetes insipidus. http://www.uptodate.com/home/index.html. Accessed June 15, 2010.
- Bichet DG. Treatment of nephrogenic diabetes insipidus. http://www.uptodate.com/home/index.html. Accessed June 15, 2010.
- Rose BD, et al. Treatment of central diabetes insipidus. http://www.uptodate.com/home/index.html. Accessed June 15, 2010.
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