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Review
. 2016 Jan-Feb;20(1):9-21.
doi: 10.4103/2230-8210.172273.

Diabetes insipidus: The other diabetes

Sanjay Kalra  1 , Abdul Hamid Zargar  2 , Sunil M Jain  3 , Bipin Sethi  4 , Subhankar Chowdhury  5 , Awadhesh Kumar Singh  6 , Nihal Thomas  7 , A G Unnikrishnan  8 , Piya Ballani Thakkar  9 , Harshad Malve  10
Affiliations
Review

Diabetes insipidus: The other diabetes

Sanjay Kalra et al. Indian J Endocrinol Metab. 2016 Jan-Feb.

Abstract

Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing of large volumes of urine, even at night. A systematic search of literature for DI was carried out using the PubMed database for the purpose of this review. Central DI due to impaired secretion of arginine vasopressin (AVP) could result from traumatic brain injury, surgery, or tumors whereas nephrogenic DI due to failure of the kidney to respond to AVP is usually inherited. The earliest treatment was posterior pituitary extracts containing vasopressin and oxytocin. The synthetic analog of vasopressin, desmopressin has several benefits over vasopressin. Desmopressin was initially available as intranasal preparation, but now the oral tablet and melt formulations have gained significance, with benefits such as ease of administration and stability at room temperature. Other molecules used for treatment include chlorpropamide, carbamazepine, thiazide diuretics, indapamide, clofibrate, indomethacin, and amiloride. However, desmopressin remains the most widely used drug for the treatment of DI. This review covers the physiology of water balance, causes of DI and various treatment modalities available, with a special focus on desmopressin.

Keywords: Antidiuretic hormone; desmopressin; polydipsia; polyuria; vasopressin.

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Figures

Figure 1
Figure 1
The arginine vasopressin system. cAMP: Cyclic adenosine monophosphate, V2R: Vasopressin-2-receptor, ADH: Antidiuretic hormone, AVP: Arginine vasopressin, Gs: G proteins, PKA: Protein kinase A
Figure 2
Figure 2
Diagnostic flowchart for central and nephrogenic diabetes insipidus. AVP: Arginine vasopressin, Posm: Plasma osmolality, Uosm: Urine osmolality
Figure 3
Figure 3
(a) Plasma 1-deamino-8-D-arginine-vasopressin concentrations (n = 9), (b) urine osmolality, and (c) urine flow rate at varying intervals after the administration of intranasal or oral desmopressin in 10 adult patients with central diabetes insipidus
Figure 4
Figure 4
Effect of single rising doses of oral desmopressin on urine osmolality in the seven pediatric patients in the study
Figure 5
Figure 5
Changes in (a) 24-h urine volume and (b) hourly diuresis rate and (c) urine osmolality over time
Figure 6
Figure 6
Diagnostic flowchart for polyuria. DM: Diabetes mellitus, CKD: Chronic kidney disease, ADH: Antidiuretic hormone, RF: Renal function, NDI: Nephrogenic diabetes insipidus, CDI: Central diabetes insipidus, MRI: Magnetic resonance imaging
See this image and copyright information in PMC

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