Diabetes Insipidus (DI) may not necessarily be a life-threatening condition, but it can create negative life impacts if it is not properly treated. Often causing people to thirst more than normal, those with this disease find themselves drinking water more often and then urinating more frequently.
What causes diabetes insipidus? The answer to that question depends on the type of DI that has been diagnosed. Sometimes this disease is passed along from parent to child. At other times, lifestyle habits may contribute to the condition. In up to 30% of cases, there isn’t a known medical cause for DI development.
Here is a look at the four different types of diabetes insipidus and what the common causes for the condition typically are.
Central Diabetes Insipidus Is Caused By Hormonal Loss
There is a hormone that is called Vasopressin that tells the kidneys when they need to absorb water or when they need to retain it. Vasopressin is what is known as an anti-diuretic hormone [ADH] and as thirst changes, the amount of hormones that are in the body adapt as well. In hot weather, during exercise, or when more fluids are demanded, the levels of ADH go up to prevent fluids from being excreted.
With central diabetes insipidus, there isn’t enough Vasopressin present to tell the kidneys what they are supposed to do. This can be caused by a wide variety of problems, but most typically results in damage to the pituitary gland or the hypothalamus in some way. Here are the common issues that may cause the development of central DI.
1. Genetic problems.
Damage to the hypothalamus or the pituitary gland can be caused by genetic transfers. Although both parents can pass a defective gene to their child that causes this health issue, fathers are more likely to do so than mothers.
2. Head injuries.
Any head trauma, such as a concussion or a traumatic brain injury, increases the risk of damage occurring that can affect hormone levels.
3. Infection.
An infection of the pituitary gland can change hormone production. Any chronic infection, however, increases the risks of disease development.
4. Loss of blood.
When the pituitary gland is not getting enough blood, then the gland can become damaged and the amount of ADH produced will be reduced or eliminated.
5. Tumor.
Pituitary gland or hypothalamus tumors have also been proven to affect hormone levels when they grow large enough or are growing in troublesome locations.
Up to 20% of people who have surgery on their pituitary gland will also develop the signs and symptoms of diabetes insipidus. Surgical causes will typically reverse themselves over time, but a small percentage of people who develop DI from surgery will have permanent complications.
Central diabetes insipidus may progress from being mild to severe. It may also appear suddenly and severely. Most people with this version of DI seek out treatment because they are concerned about always being thirsty or they have noticed changes in their urination patterns. The most important factor to track if the condition isn’t caused genetically is to determine if pituitary or hypothalamus damage continues to increase. Regular MRI examinations can help to track disease progression in these circumstances.
Nephrogenic Diabetes Insipidus Is Caused By the Kidneys
Nephrogenic diabetes insipidus is more rare than the central version of DI. Instead of there not being enough Vasopressin, with this version of DI, a person’s kidneys fail to recognize the ADH and what it is trying to communicate. The most common reason why this occurs is because of a defect within the kidneys themselves or a genetic condition that has been passed from parent to child. Nephrogenic DI may be present and exhibit signs and symptoms in newborns.
There are three additional causes of this type of diabetes insipidus.
1. Medication.
There are certain medications that can cause the kidneys to stop communicating with the ADH in the body. The primary culprit is lithium, but there are several other drugs that can also cause this issue.
2. Hypercalcemia.
When there is too much calcium in the body, it begins to interfere with the communication matrix between the kidneys and the Vasopressin.
3. Disease.
Several kidney diseases may also damage the organs and make it impossible for the kidneys to respond to ADH levels. Polycystic kidney disease is the most common culprit for this, but anything that negatively affects the kidneys will increase a person’s risk for DI development.
Unless the issue is genetic in nature, the good news is that diabetes insipidus that is caused by outside components can often be successfully treated. Medications can be changed, calcium levels can be reduced, or the underlying disease can be treated or cured and this will often eliminate DI completely.
Sometimes the damage that occurs from having too much calcium or from the side effects of certain medications can create long-term problems with DI even when kidney disease may not be present. Some medications also take several weeks or months to completely leave the body. This is why an early diagnosis of nephrogenic DI can help to start a treatment plan that will effectively treat the disorder.
Gestational Diabetes Insipidus Has Just One Cause
Only women can develop gestational diabetes insipidus. That is because it occurs only when a pregnancy has occurred. As the placenta develops to support the growing fetus and transfer nutrients and wastes between mother and child, an enzyme is produced that interacts with the Vasopressin in the mother’s body. Sometimes this enzyme can actually destroy the ADH that is present, which creates the symptoms of DI.
For most women, this situation is temporary and resolves after giving birth and the placenta is removed. In rare cases, however, ongoing symptoms can continue on throughout the rest of their life.
There is nothing that can be done to prevent this form of DI from occurring. It will either affect the blood vessels of the mother or it will not. An OB-GYN will look for this issue after a pregnancy has been confirmed. For women who are of child-bearing age and report with DI symptoms, a pregnancy test is considered a standard diagnostic tool.
Primary Polydipsia Is “Self Caused” Diabetes Insipidus
Primary polydipsia, which some might call dipsogenic DI or psychogenic polydipsia, occurs when lifestyle habits create the foundation for disease development. Instead of there being damage to the pituitary gland, the kidneys, or the hypothalamus, the ADH levels in the body are actually normal. The kidneys respond to the ADH appropriately. What causes the diabetes insipidus is chronic excessive fluid intake.
When a person drinks too much water during the day, their urine becomes diluted because the body doesn’t need that many fluids. The urine comes out very clear and the waste products are not concentrated. With primary polydipsia, this habit occurs every day and over time, this affects how the kidneys react. Urine eventually stops being concentrated and excessive thirst develops because the body needs fluids to cleanse itself of waste products.
In rare cases, the hypothalamus can be responsible for this form of diabetes insipidus because it controls the thirst regulation centers of the body. Mental illnesses, however, are typically the cause of this version of DI. Behavioral disorders may also contribute to the situation.
How Severe Is Diabetes Insipidus?
All four versions of diabetes insipidus may range from being very mild to very severe. Mild cases may cause an increased level of thirst throughout the day, but one that is barely noticeable. In severe cases, people may feel like they are always thirsty, even when they drink several liters of fluids throughout the day.
The biggest risk of DI is that it may cause dehydration or an electrolyte imbalance because fluid levels within the body have become out of balance. Watch for the signs and symptoms of low sodium levels especially, such as low blood pressure, fatigue, irritability, and muscle twitches or pain.
What Can Reduce the Risks of Diabetes Insipidus Development?
There really is no way to proactively prevent the development of diabetes insipidus. Most known cases that have a medical explanation are caused by genetic issues or injuries. If you are taking a medication like lithium, however, you may wish to speak with your doctor about changing your medication if DI development is a concern of yours.
The best thing to do is to eat a healthy diet, drink fluids when thirsty, and avoid diuretics like caffeine when possible. Exercise regularly and maintain a healthy body weight. Even so, everyone carries a certain risk of disease development because something as simple as a concussion from an automobile accident can cause DI.
Most cases of diabetes insipidus are not treated unless the symptoms become bothersome. DI does not cause kidney failure or require an individual to seek out dialysis. If you believe that you may have diabetes insipidus, then speak with your doctor about your medical history and if there is anything that can be done to treat the condition.