Causes of Autoimmune Diabetes Insipidus
Autoimmune Diabetes Insipidus Causes: Book Excerpts
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Polydipsia:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Diabetes mellitus (type I and type II)
–Hyperglycemia drives an osmotic diuresis that causes polyuria, which then leads to dehydration, increased thirst, and polydipsia
-
Diabetes insipidus
–Abnormal water balance due to vasopressin (ADH) deficiency or resistance, causing excretion of large amounts of dilute urine
-
Central or neurogenic diabetes insipidus
(vasopressin deficiency)
–Congenital
–Familial (autosomal dominant)
–Acquired: Neurosurgery, tumor (e.g.,
craniopharyngioma), head trauma, infiltrative/inflammatory, infectious
-
Nephrogenic diabetes insipidus (decreased responsiveness of the kidneys to vasopressin)
–Familial (X-linked dominant and recessive forms)
–Acquired: Renal disease, obstructive uropathy, hypercalcemia/hypercalciuria
–Hypokalemia, drug-induced (e.g., lithium, diuretics, ethanol, cisplatin)
–Gestational DI: Increased clearance of ADH by placental vasopressinase, lower osmolar threshold for thirst and ADH release
-
Primary polydipsia
–Compulsive water drinking
–Dipsogenic DI
-
Primary hyperaldosteronism
-
Diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD) syndrome
-
Bartter syndrome
-
Hypertension (e.g., pheochomocytoma)
-
Neuroblastoma
-
Cystinosis
-
Congestive heart failure
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Polydipsia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Diabetes insipidus
Diabetes insipidus characteristically produces polydipsia and may also cause excessive voiding of dilute urine and mild to moderate nocturia. Fatigue and signs of dehydration occur in severe cases.
Diabetes mellitus
Polydipsia is a classic finding with diabetes mellitus — a consequence of the hyperosmolar state. Other characteristic findings include polyuria, polyphagia, nocturia, weakness, fatigue, and weight loss. Signs of dehydration may occur.
Hypercalcemia
As hypercalcemia progresses, the patient develops polydipsia, polyuria, nocturia, constipation, paresthesia and, occasionally, hematuria and pyuria. Severe hypercalcemia can progress quickly to vomiting, a decreased level of consciousness, and renal failure. Depression, mental lassitude, and increased sleep requirements are common.
Hypokalemia
Hypokalemia is an electrolyte imbalance that can cause nephropathy, resulting in polydipsia, polyuria, and nocturia. Related hypokalemic signs and symptoms include muscle weakness or paralysis, fatigue, decreased bowel sounds, hypoactive deep tendon reflexes, and arrhythmias.
Psychogenic polydipsia
Psychogenic polydipsia is an uncommon disorder that causes polydipsia and polyuria. It may occur with any psychiatric disorder, but is more common with schizophrenia. Signs of psychiatric disturbances, such as anxiety or depression, are typical. Other findings include a headache, blurred vision, weight gain, edema, elevated blood pressure and, occasionally, stupor and coma. Signs of heart failure may develop with overhydration.
Renal disorders (chronic)
Chronic renal disorders, such as glomerulonephritis and pyelonephritis, damage the kidneys, causing polydipsia and polyuria. Associated signs and symptoms include nocturia, weakness, elevated blood pressure, pallor and, in later stages, oliguria.
Sheehan’s syndrome
Polydipsia, polyuria, and nocturia occur with Sheehan’s syndrome, a disorder of postpartum pituitary necrosis. Other features include fatigue, failure to lactate, amenorrhea, decreased pubic and axillary hair growth, and a reduced libido.
Sickle cell anemia
As nephropathy develops, polydipsia and polyuria occur. They may be accompanied by abdominal pain and cramps, arthralgia and, occasionally, lower extremity skin ulcers and bone deformities, such as kyphosis and scoliosis.
Other causes
Drugs
Diuretics and demeclocycline may produce polydipsia. Phenothiazines and anticholinergics can cause dry mouth, making the patient so thirsty that he drinks compulsively.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Diabetes insipidus:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Diabetes insipidus results centrally from intracranial neoplastic or metastatic lesions, hypophysectomy or other neurosurgery, a skull fracture, or head trauma that damages the neurohypophyseal structures. It can also result nephrogenically from infection, granulomatous disease, and vascular lesions; it may be idiopathic and, rarely, familial. (Note: Pituitary diabetes insipidus shouldn’t be confused with nephrogenic diabetes insipidus, a rare congenital disturbance of water metabolism that results from renal tubular resistance to vasopressin.)
Normally, the hypothalamus synthesizes vasopressin. The posterior pituitary gland (or neurohypophysis) stores vasopressin and releases it into general circulation, where it causes the kidneys to reabsorb water by making the distal tubules and collecting duct cells water-permeable. The absence of vasopressin in diabetes insipidus allows the filtered water to be excreted in the urine instead of being reabsorbed.
Nephrogenic diabetes insipidus involves a defect in the parts of the kidneys that reabsorb water back into the bloodstream. It occurs less commonly than central diabetes insipidus. Nephrogenic diabetes insipidus may occur as an inherited disorder in which male children receive the abnormal gene that causes the disease on the X chromosome from their mothers. Nephrogenic diabetes insipidus may also be caused by diseases of the kidney (such as polycystic kidney disease) and the effects of certain drugs (such as lithium and amphotericin B).
Diabetes insipidus is rare, affecting 1 in 25,000 people. Males and females are affected equally.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Polydipsia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Diabetes insipidus
This disorder characteristically produces polydipsia and may also cause excessive voiding of dilute urine and mild to moderate nocturia. Fatigue and signs of dehydration occur in severe cases.
Diabetes mellitus
Polydipsia is a classic finding with this disorder—a consequence of the hyperosmolar state. Other characteristic findings include polyuria, polyphagia, nocturia, weakness, fatigue, and weight loss. Signs of dehydration may occur.
Hypercalcemia
As this disorder progresses, the patient develops polydipsia, polyuria, nocturia, constipation, paresthesia and, occasionally, hematuria and pyuria. Severe hypercalcemia can progress quickly to vomiting, decreased level of consciousness, and renal failure. Depression, mental lassitude, and increased sleep requirements are common.
Hypokalemia
This electrolyte imbalance can cause nephropathy, resulting in polydipsia, polyuria, and nocturia. Related hypokalemic signs and symptoms include muscle weakness or paralysis, fatigue, decreased bowel sounds, hypoactive deep tendon reflexes, and arrhythmias.
Psychogenic polydipsia
This uncommon disorder causes polydipsia and polyuria. This condition may occur with any psychiatric disorder, but more common with schizophrenia. Signs of psychiatric disturbances, such as anxiety or depression, are typical. Other findings include headache, blurred vision, weight gain, edema, elevated blood pressure and, occasionally, stupor and coma. Signs of heart failure may develop with overhydration.
Renal disorders (chronic)
Chronic renal disorders, such as glomerulonephritis and pyelonephritis, damage the kidneys, causing polydipsia and polyuria. Associated signs and symptoms include nocturia, weakness, elevated blood pressure, pallor and, in later stages, oliguria.
Sheehan’s syndrome
Polydipsia, polyuria, and nocturia occur within this syndrome of postpartum pituitary necrosis. Other features include fatigue, failure to lactate, amenorrhea, decreased pubic and axillary hair growth, and reduced libido.
Sickle cell anemia
As nephropathy develops, polydipsia and polyuria occur. They may be accompanied by abdominal pain and cramps, arthralgia and, occasionally, lower extremity skin ulcers, and bone deformities, such as kyphosis and scoliosis.
Thyrotoxicosis
This disorder infrequently causes polydipsia. Characteristic findings include tachycardia, palpitations, weight loss despite increased appetite, diarrhea, tremors, an enlarged thyroid, dyspnea, nervousness, diaphoresis, and heat intolerance. Exophthalmos may also occur.
Other causes
Drugs
Diuretics and demeclocycline may produce polydipsia. Phenothiazines and anticholinergics can cause dry mouth, making the patient so thirsty that he drinks compulsively.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Diabetes insipidus:
Causes
(Handbook of Diseases)
Pituitary diabetes insipidus results from intracranial neoplastic or metastatic lesions, hypophysectomy or other neurosurgery, a skull fracture, or head trauma that damages the neurohypophyseal structures. It can also result from infection, granulomatous disease, and vascular lesions; it may be idiopathic and, rarely, familial.
The hypothalamus synthesizes vasopressin. The posterior pituitary gland (or neurohypophysis) stores vasopressin and releases it into the general circulation, where it causes the kidneys to reabsorb water by making the distal tubules and collecting duct cells water-permeable.
In pituitary diabetes insipidus, the absence of vasopressin allows the filtered water to be excreted in the urine instead of being reabsorbed. In renal diabetes insipidus, the kidney doesn’t respond to vasopressin, which is usually present in high concentrations.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chronic fatigue and immune dysfunction syndrome:
Causes
(Handbook of Diseases)
Although the cause of CFIDS is unknown, researchers suspect that it may be found in human herpesvirus 6 or in other herpesviruses, enteroviruses, or retroviruses. Rising levels of antibodies to EBV, once thought to implicate EBV infection as the cause of CFIDS, are now considered a result of this disease.
CFIDS may be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include sex, age, genetic disposition, prior illness, stress, and environment.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Polydipsia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Diabetes insipidus
Diabetes insipidus characteristically produces polydipsia and may also cause excessive voiding of dilute urine and mild to moderate nocturia. Fatigue and signs of dehydration occur in severe cases.
Diabetes mellitus
Polydipsia is a classic finding with diabetes mellitus — a consequence of the hyperosmolar state. Other characteristic findings include polyuria, polyphagia, nocturia, weakness, fatigue, and weight loss. Signs of dehydration may occur. (See Associated disorder: Diabetes mellitus, page 514.)
CULTURAL CUE:Diabetes is the fourth leading cause of death in Black, Native American, Hawaiian, and Filipino women. Also, Blacks are at greater risk for developing diabetes than Whites.
Hypercalcemia
As hypercalcemia progresses, the patient develops polydipsia, polyuria, nocturia, constipation, paresthesia and, occasionally, hematuria and pyuria. Severe hypercalcemia can progress quickly to vomiting, decreased level of consciousness, and renal failure. Depression, mental lassitude, and increased sleep requirements are common.
Hypokalemia
An electrolyte imbalance — hypokalemia — can cause nephropathy, resulting in polydipsia, polyuria, and nocturia. Related hypokalemic signs and symptoms include muscle weakness or paralysis, fatigue, decreased bowel sounds, hypoactive deep tendon reflexes, and arrhythmias.
Renal disorders (chronic)
Chronic renal disorders, such as glomerulonephritis and pyelonephritis, damage the kidneys, causing polydipsia and polyuria. Associated signs and symptoms include nocturia, weakness, elevated blood pressure, pallor and, in later stages, oliguria.
Sickle cell anemia
As nephropathy develops in patients with sickle cell anemia, polydipsia and polyuria occur. They may be accompanied by abdominal pain and cramps, arthralgia and, occasionally, lower extremity skin ulcers and such bone deformities as kyphosis and scoliosis.
Other causes
Drugs
Diuretics and demeclocycline may produce polydipsia. Phenothiazines and anticholinergics can cause dry mouth, making the patient so thirsty that he drinks compulsively.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Polyuria and Polydipsia:
Principal Causes of Polyuria and Polydipsia
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Diabetesmellitus
- Diabetes insipidus
- Antidiuretichormone deficiency (central diabetes insipidus)
- Antidiuretic hormone resistance (nephrogenicdiabetes insipidus)
- Primary polydipsia
- Compulsivewater drinking
- Hypothalamic thirst center defect
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Polydipsia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Diabetes insipidus.Diabetes insipidus characteristically produces polydipsia and may also cause excessive voiding of dilute urine and mild to moderate nocturia. Fatigue and signs of dehydration occur in severe cases.
Diabetes mellitus.Polydipsia is a classic finding with diabetes mellitus—a consequence of the hyperosmolar state. Other characteristic findings include polyuria, polyphagia, nocturia, weakness, fatigue, and weight loss. Signs of dehydration may occur.
Hypercalcemia.As hypercalcemia progresses, the patient develops polydipsia, polyuria, nocturia, constipation, paresthesia and, occasionally, hematuria and pyuria. Severe hypercalcemia can progress quickly to vomiting, decreased level of consciousness, and renal failure. Depression, mental lassitude, and increased sleep requirements are common.
Hypokalemia.Hypokalemia can cause polydipsia, polyuria, and nocturia. Related hypokalemic signs and symptoms include muscle weakness or paralysis, fatigue, decreased bowel sounds, hypoactive deep tendon reflexes, and arrhythmias.
Psychogenic polydipsia.Psychogenic polydipsia causes polydipsia and polyuria. It may occur with any psychiatric disorder, but is more common with schizophrenia. Signs of psychiatric disturbances, such as anxiety or depression, are typical. Other findings include headache, blurred vision, weight gain, edema, elevated blood pressure and, occasionally, stupor and coma. Signs of heart failure may develop with overhydration.
Renal disorders (chronic).Chronic renal disorders, such as glomerulonephritis and pyelonephritis, damage the kidneys, causing polydipsia and polyuria. Associated signs and symptoms include nocturia, weakness, elevated blood pressure, pallor and, in later stages, oliguria.
Sheehan's syndrome.Polydipsia, polyuria, and nocturia occur with Sheehan's syndrome, a disorder of postpartum pituitary necrosis. Other features include fatigue, failure to lactate, amenorrhea, decreased pubic and axillary hair growth, and a reduced libido.
Sickle cell anemia.With sickle cell anemia, as nephropathy develops, polydipsia and polyuria occur. They may be accompanied by abdominal pain and cramps, arthralgia and, occasionally, lower extremity skin ulcers and bone deformities, such as kyphosis and scoliosis.
Other causes
Drugs.Diuretics and demeclocycline may produce polydipsia. Phenothiazines and anticholinergics can cause dry mouth, making the patient so thirsty that he drinks compulsively.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Diabetes Insipidus:
Diabetes Insipidus - pathophysiology
(The 5-Minute Pediatric Consult)
- Antidiuretic hormone stimulates the formation of cyclic adenosine monophosphate (cAMP) in the renal collecting ducts, thereby increasing water permeability and increasing reabsorption of free water.
- Lack of antidiuretic hormone effect results in urinary loss of free water.
- Patients with an intact thirst mechanism drink copiously (polydipsia) to compensate for free water loss.
- If the thirst mechanism is not present or if access to free water is limited (e.g., infants or vomiting), severe dehydration can occur.
Diabetes Insipidus - etiology
- Insufficient antidiuretic hormone secretion:
- Traumatic or postsurgical
- Nonaccidental injury in children
- Related to tumor invasion of posterior pituitary
- Extension from anterior pituitary/suprasellar: Optic glioma, rarely adenomas
- Hypothalamic: Germinoma, craniopharyngioma, meningioma
- Lymphoma
- Granulomas: Histiocytosis X, sarcoidosis
- Metastatic carcinoma
- Post–severe ischemic or hypoxic injury to the brain
- Familial (autosomal dominant)
- Congenital malformation of CNS
- Infection
- Viral encephalitis
- Meningitis
- Tuberculosis
- Increased metabolic clearance of antidiuretic hormone (gestational diabetes insipidus)
- Drug- or toxin-related: Snake venom, tetrodotoxin
- Autoimmune disorders: Hypophysitis
- Psychogenic: Excessive water drinking
- Idiopathic: Must observe for many years to exclude slow-growing tumors
- Unresponsive to antidiuretic hormone:
- Familial or nephrogenic (X-linked dominant and autosomal-recessive forms)
- Tumor related
- Urinary tract obstruction, especially in utero
- Renal medullary cystic disease
- Electrolyte disturbances: Hypokalemia, hypercalcemia (hypercalciuria)
- Drugs: Usually reversible (diuretics, diphenylhydantoin, reserpine, cisplatin, rifampin, lithium [may become permanent], demeclocycline, ethanol, chlorpromazine, volatile anesthetics, foscarnet, amphotericin B)
- Loss of the medullary concentrating gradient owing to excessive free water intake relative to solute intake
Pitfalls:
- Management of patients without an intact thirst mechanism and of newborns is difficult.
- Patients with psychogenic polydipsia may fail a water deprivation test because prolonged excessive water intake can wash out the renal medullary gradient required for concentrating the urine.
- Surreptitious water intake during water deprivation test
- Idiopathic, acquired diabetes insipidus can be caused by slowly growing brain tumors not visible on the initial magnetic resonance image.
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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