Central Diabetes Insipidus

Chloe de Crecy

Definition

  • Lack of antidiuretic hormone results in free water excreted at kidneys

Etiology

  • Idiopathic, autoimmune, tumors (primary or secondary), infiltrative (Langerhans cell histiocytosis), congenital, trauma, surgery, severe shock/ischemia

Presentation

  • Polyuria, nocturia, polydipsia
  • Elevated Na and osmolality, only if impaired thirst. Can be normal due to compensatory thirst
  • Decreased bone mineral density (unclear pathophysiology)

Evaluation

  1. Confirm polyuria w/ low Uosm (DDx: psychogenic polydipsia, central DI, nephrogenic DI)
  2. Water restriction. If urine concentrates (Uosm>700), it is primary polydipsia not DI.
  3. Desmopressin trial (after Na >145) to differentiate between nephrogenic vs central. Central DI responds to desmopressin.
  4. MRI to investigate cause

Management

  • Desmopressin (ADH analog) - PO, IV forms. Given at bedtime.
  • Goal: reduce nocturia to improve sleep
  • Risk: hyponatremia
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