There may be four types of diabetes insipidus that are known, but the most common version of this condition is known as cranial diabetes insipidus. This refers to the fact that the hypothalamus is not correctly producing the amount of vasopressin, an anti-diuretic hormone created by the brain itself, that is required for a proper balance. The end result is that the kidneys will not stop urine creation to concentrate it, resulting in very diluted urine that is passed frequently throughout the day.
What Causes Cranial Diabetes Insipidus?
There are a wide variety of reasons why cranial diabetes insipidus may become a health issue that needs to be addressed. Between 25-30% of cases that are diagnosed, however, have no discernible cause behind the condition that causes the hypothalamus to produce a reduced or limited amount of anti-diuretic hormone.
In the cases that do have a specific cause, one of the most common reasons for the condition to develop is because of an injury that occurs to the hypothalamus. This may be from an impact injury, trauma from a surgery in that region, or even inflammation that occurs after an injury that puts pressure on the hypothalamus.
Tumors are also known to be a cause of cranial diabetes insipidus. A brain tumor at or near the hypothalamus may cause these bothersome symptoms, as can a tumor that occurs on the pituitary gland. Certain types of cranial diabetes insipidus are known to be genetic in nature, while condictions that affect the entire body, such as sarcoidosis, may also create bothersome symptoms.
Cranial diabetes insipidus has also been linked to tuberculosis infections.
What Are the Symptoms of Cranial Diabetes Insipidus?
The primary symptom of cranial diabetes insipidus is a large amount of urine that is very diluted that gets passed out of the body several times during the day. If regular fluids are being consumed, it is possible for someone to pass up to 20 liters of urine over the course of a day.
The urge to urinate is frequent with this condition whether or not there are fluids being consumed. Because the kidneys are waiting for the vasopressin to tell them to begin concentrating the urine, when it never comes, the bladder will fill up immediately with whatever water can come out of the body. This may be removed from tissues, the bloodstream itself, and any other water source that may be available. Without proper fluid intake, this can quickly cause dehydration to begin setting in.
It is also common to experience an increased level of thirst when cranial diabetes insipidus begins to have an impact on the body. This thirst may be present at all times, even waking some people up in the middle of the night. Many people find that they must get up several times during the night to use the restroom as well when this condition is not brought under control.
How Is Cranial Diabetes Insipidus Diagnosed?
If cranial diabetes insipidus is suspected, then a medical provider will typically order a complete fast in conjunction with a 12/24 urine sample. There will still be high levels of urine produced even during the fasting period when diabetes insipidus is present. If the urine levels decrease or cease, then this will usually indicate that another condition is causing the bothersome symptoms.
Blood and urine tests will also typically be ordered so that specific results can be looked at. Medical providers are looking for high serum levels in the blood and high sodium levels. Hourly tests during the fasting period may be ordered, along with blood pressure readings, weight results, and the total quanity of urine that is passed.
An injection of desmopressin is also typically part of the diagnostic process. This will help medical providers to be able to determine if the diabetes insipidus is cranial in nature or nephrogenic instead.
How Is Cranial Diabetes Insipidus Treated?
The most common method of treatment for cranial diabetes insipidus is the use of a synthetic hormone called desmopressin. This synthetic hormone supplements the natural levels of vasopressin that are being produced by the hypothalamus. It is also a longer lasting hormone, so one dose is typically all that is needed throughout the day. It can be administered through tables or a nose spray.
Certain other medications are also available to treat this condition. Increased fluid intake is almost always recommended, as is a reduction or elimination of caffeine.
Some people may be able to treat their condition by increasing the amount of fluids that they consume during the day. This helps to prevent dehydration from setting in as the body begins to work on repairing itself. The end result is usually an increase of urine for the first several days of pushing fluids, but then may begin to taper off.
There are also some natural remedies that are recommended by some providers that may or may not be effective. One of the most common natural remedies is to place a belladonna plaster over the affected area and leave it there for up to 3 hours at a time. This is complimented by internal intake of the supplement after each 3 hour period.
Vitamin B5 has also been said to be effective in preventing excessive urine. Drops of fragrant sumac have also been recommended by homeopathic providers as a method of slowing down or even stopping the bothersome symptoms of cranial diabetes insipidus.
Cranial Diabetes Insipidus Is Not Diabetes Mellitus
Both conditions are called diabetes because of the symptoms that they create. Diabetes mellitus in both types are able to cause excessive thirst and urination. The difference is that diabetes mellitus is an issue with blood sugar levels, while diabetes insipidus is an issue with fluid retention. Although someone may have both types of diabetes, one condition does not automatically lead to the other condition forming.
How Common is Cranial Diabetes Insipidus?
Cranial diabetes insipidus is rather rare in the general population. About 1 in 25,000 people will be diagnosed with the condition. This figure may be under-reported, however, because mild forms of this condition are easy to self-manage and may never be reported to a medical provider. If there are no bothersome symptoms with cranial diabetes insipidus, then it is not uncommon for medical providers to recommend a wait-and-see approach.
For those who have gone through pituitary gland surgery in the recent past, there is a 1 in 5 chance that some level of cranial diabetes insipidus may develop temporarily. The same is true for women who may be pregnant, which may also present itself as gestational diabetes insipidus. These cases typically resolve themselves over time and may not ever require desmopressin or other treatment options.
How to Prepare to Be Treated for Cranial Diabetes Insipidus
Only a medical provider can confirm whether or not cranial diabetes insipidus is the cause of the bothersome symptoms that are being experienced. A treatment plan will be developed after consultation and testing that may include input from a number of specialists and a family physician. Although some local offices are able to test for cranial diabetes insipidus, results typically take 3-5 business days to be reported because of shipment and processing times.
It is important to keep track of any bothersome symptoms in a diary to help with the diagnostic process. Keep track of how much urine is being passed throughout the day, how make glasses of water are being consumed, and other lifestyle habits. Don’t ignore anything because this information can lead a physician toward a specific diagnosis. Any medical procedures in the recent past, highly stressful situations, and an updated list of medications are also key components of the initial evaluation for this condition.
Does Cranial Diabetes Insipidus Ever Disappear?
Most causes of cranial diabetes insipidus will go away once the underlying cause of the condition either heals or receives an appropriate level of treatment. About 20% of people who have a surgery on their pituitary gland will wind up having this condition, as will a small number of those who experience a concussion or other traumatic injury to the head. It is very rare for cranial diabetes insipidus to become a permanent condition.
For some individuals, the bothersome symptoms of this condition will begin to fade as soon as the fluid requirements the body has are restored to balance. This may mean drinking up to 30 liters of fluid over the course of a day for several days in a row to help “kickstart” hormone production within the hypothalamus.
Ongoing health issues may begin to form after cranial diabetes insipidus is resolved because of electrolyte imbalances or persistent dehydration. Headaches, muscle twitches, difficulty sleeping, dizziness, nausea, and other symptoms may be prolonged without treatment even though the diabetes insipidus has gone into remission. Others may find that they need to take desmopressin as needed for the rest of their lives.
Only a medical provider can answer specific questions about cranial diabetes insipidus and how it relates to a personal medical history. Schedule an appointment to discuss this condition, bring along a diary of symptoms and urinary behavior, and most people will be able to receive the answers they need regarding their personal health.