Diabetes Insipidus Clinical Presentation

  • Author: Michael Cooperman, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Jun 17, 2011
 

History

The clinical presentation of diabetes insipidus (DI) depends on the cause, the severity, and the associated medical condition(s) of the patient.

The most common form of DI is that which follows trauma or surgery to the region of the pituitary and hypothalamus. It may exhibit 1 of 3 patterns: transient, permanent, or triphasic. The triphasic pattern is observed more often clinically. The 3 phases of this pattern are as follows:

  • The first phase is a polyuric one that lasts 4-5 days, caused by inhibition of antidiuretic hormone (ADH). An immediate increase in urine volume and a concomitant fall in urine osmolality occur.
  • The second phase is an antidiuretic one that lasts 5-6 days, resulting from the release of stored hormone. Urine osmolality rises.
  • The third phase can be permanent DI, when stores of ADH are exhausted and the cells that produce more ADH are absent or unable to produce.

Polyuria, polydipsia, and nocturia (from 3-18 L) are the predominant symptoms. In infants, crying, irritability, growth retardation, hyperthermia, and weight loss may be the most apparent signs. In children, enuresis, anorexia, linear growth defects, and fatigability typically predominate. Pregnancy is associated with an increased risk of DI. When it has a nontraumatic cause, DI typically has a much more indolent course.

Many patients have a predilection for drinking cold liquids, often water. Neurologic symptoms vary with the patient’s access to water; patients with free access may have no symptoms at all.

Symptoms and signs of simultaneous anterior pituitary dysfunction may be present but are rare.

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Physical Examination

The physical examination varies with the severity and chronicity of DI. The examination findings may be entirely normal. Hydronephrosis, bladder enlargement, and signs of dehydration are common. The daily urine volume is highly variable (3-20 L/d), and patient tolerance of dehydration also varies among individuals. Aside from signs of dehydration and an enlarged bladder, no specific signs of DI exist.

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Contributor Information and Disclosures
Author

Michael Cooperman, MD  Clinical Associate Professor of Endocrinology, Temple University School of Medicine; Chair, Department of Internal Medicine, Division of Endocrinology, Jeanes Hospital

Michael Cooperman, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Clinical Endocrinologists, and Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Frederick H Ziel, MD  Associate Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group

Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society for Bone and Mineral Research, California Medical Association, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Romesh Khardori, MD, PhD, FACP  Former Professor, Department of Medicine, Former Chief, Division of Endocrinology, Metabolism, and Molecular Medicine, Southern Illinois University School of Medicine

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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  3. Rochdi MD, Vargas GA, Carpentier E, et al. Functional Characterization of V2-Vasopressin Receptor Substitutions (R137H/C/L) Leading to Nephrogenic Diabetes Insipidus and Nephrogenic Syndrome of Inappropriate Antidiuresis; Implications for treatments. Mol Pharmacol. Feb 16 2010;[Medline]. [Full Text].

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  14. Ausiello JC, Bruce JN, Freda PU. Postoperative assessment of the patient after transsphenoidal pituitary surgery. Pituitary. 2008;11(4):391-401. [Medline].

 
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