Diabetes Insipidus

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Diabetes Insipidus (DI) is a disease of the pituitary gland or kidney. These rare disorder, causing frequent and heavy urination, as well as excessive thirst. However, do not confused it with diabetes mellitus.  Despite the similarities in symptoms and name, the two disease aren't related. In diabetes insipidus (DI), blood glucose levels are normal.

There are 4 fundamentally different types of Diabetes Insipidus (DI): 

• Neurogenic - also known as central, hypothalamic, pituitary or neurohypophyseal is caused by a deficiency of the antidiuretic hormone, vasopressin.

• Nephrogenic - also known as vasopressin-resistant is caused by insensitivity of the kidneys to the effect of the antidiuretic hormone, vasopressin.

• Gestagenic - also known as gestational is also caused by a deficiency of the antidiuretic hormone, vasopressin, that occurs only during pregnancy.

• Dipsogenic - a form of primary polydipsia is caused by abnormal thirst and the excessive intake of water or other liquids.

Causes
Kidneys remove any excess body fluids from our bloodstream. Removed excess fluid waste is then stored in the bladder as urine. in order to keep the volume and composition of body fluids balanced, the rate of fluid intake is governed by thrist, and the rate of excretion is governed by the production of antidiuretic hormone (ADH), also known as vasopressin.

ADH is a hormone produced in a region of the brain called the hypothalamus. It is then stored and released from the pituitary gland when necessary. ADH acts in directing kidneys to concentrate the urine by returning excess water to the bloodstream and therefore produce less urine.

DI occurs when the system for regulating the kidneys' handling of fluid is disrupted. Central DI is the most common form of DI, caused from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Nephrogenic, is another form of DI, a defect in the parts of the kidneys that reabsorb water back into the bloodstream.

DI may have several causes which are as follows:

• Tumor of the pituitary gland;

• Head injury, with damage to pituitary gland;

• Brain tumor;

• Infections, such as meningitis, tuberculosis, or encephalitis;

• Hemorrhage in the pituitary gland or in adjacent structures;

• Atherosclerosis (hardening of the arteries).;

• Kidney disease;

• Sarcoidosis;

• Heredity;

• Some medicines, like lithium, can also cause it.

Diagnosis
Doctors suspect DI in people who produce large amounts of urine. Because DI and DM have the similar symptoms, They first test the urine for sugar to rule out diabetes mellitus and make the diagnosis clear. In order the determine the form of DI for proper treatment, a series of test will be carry-out, including urinalysis and fluid deprivation test.

Urinalysis is the physical and chemical examination of urine. The urine of a person with DI will be less concentrated. Therefore, the salt and waste concentrations are low, and the amount of water excreted is high. A physician evaluates the concentration of urine by measuring how many particles are in a kilogram of water (osmolality) or by comparing the weight of the urine to an equal volume of distilled water (specific gravity).

A fluid deprivation test helps determine whether DI is caused by excessive intake of fluid, or a defect in ADH production, or a defect in the kidneys' response to ADH. This test measures changes in body weight, urine output, and urine composition when fluids are withheld. Sometimes measuring blood levels of ADH during this test is also necessary.

In some patients, an MRI (magnetic resonance imaging) of the brain may be necessary as well.
In some patients, a CT (computed tomographic) scan or an MRI (magnetic resonance image)of the brain may be necessary as well. These scans are a little like x-rays. The scans would show if you have a problem in your brain

Treatment
Treatment involves controlling fluid balance and preventing dehydration; and identifying and eliminating the cause of the DI.

Medication is also available in treating DI, such as,
- Vasopressin or desmopressin acetate, modified  synthetic forms of antidiuretic hormone, may be taken as a nasal spray several times a day, to maintain a normal urine output. However, taking too much of this medication can cause fluid retention and swelling and other problems.
- Sometimes diabetes insipidus can be controlled with drugs that stimulate  production of antidiuretic hormone such as chlorpropamide, carbamazepine, clofibrate.

To achieve optimal outcome, it is important for patients to work closely with their doctors to accurately diagnose the condition, identify the underlying cause, and start treatment.

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