Diabetes Insipidus in Children

What is diabetes insipidus?

Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone (ADH), a hormone that helps the kidneys and body conserve the correct amount of water. Normally, the antidiuretic hormone controls the kidneys' output of urine. It is secreted by the hypothalamus (a small gland located at the base of the brain), stored in the pituitary gland, and then released into the bloodstream. ADH is secreted to decrease the amount of urine output so that dehydration does not occur. Diabetes insipidus, however, causes excessive production of very diluted urine and excessive thirst. The disease is categorized into groups:

• Central diabetes insipidus. An insufficient production or secretion of ADH; can be a result of damage to the hypothalamus or pituitary gland caused by head injuries, genetic disorders, and other diseases.

• Nephrogenic diabetes insipidus. A lack of kidney response to normal levels of ADH: can be caused by drugs or chronic disorders, such as kidney failure, sickle cell disease, or polycystic kidney disease.

What causes diabetes insipidus?

Diabetes insipidus can be caused by several conditions, including the following:

• Malfunctioning hypothalamus (that produces too little ADH)

• Malfunctioning pituitary gland (that fails to release ADH into the bloodstream)

• Damage to hypothalamus or pituitary gland during surgery

• Brain injury

• Tumor

• Tuberculosis

• Blockage in the arteries leading to the brain

• Encephalitis (inflammation of the brain)

• Meningitis (inflammation of the meninges, the membranes that cover the brain and spinal cord)

• Sarcoidosis (a rare inflammation of the lymph nodes and other tissues throughout the body)

• Family heredity

What are the symptoms of diabetes insipidus?

The following are the most common symptoms of diabetes insipidus. However, each child may experience symptoms differently. Symptoms may include:

• Excessive thirst

• Excessive urine production

• Dehydration

Infants with diabetes insipidus may also exhibit the following symptoms:

• Irritability

• Poor feeding

• Failure to grow

• High fevers

The symptoms of diabetes insipidus may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

How is diabetes insipidus diagnosed?

In addition to a complete medical history and physical examination, including the child's daily fluid intake, dietary intake, and voiding (bowel and bladder elimination) patterns, diagnostic procedures for diabetes insipidus may include:

• Urine tests.

• Blood tests

• Water deprivation test. To observe if dehydration occurs.

• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; to check for pituitary abnormalities.

How is diabetes insipidus treated?

If left untreated in children, diabetes insipidus can lead to brain damage, impaired mental function, mental retardation, hyperactivity, short attention span, and/or restlessness. Treatment for diabetes insipidus depends on what is causing the disease. Treating the cause usually treats the diabetes insipidus. Specific treatment for diabetes insipidus will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment may include modified antidiuretic hormone medications (often taken as a nasal spray), or medications that stimulate the production of the antidiuretic hormone. In addition, persons with diabetes insipidus must maintain adequate fluid intake to compensate for the excessive urinary output, and eat a low-sodium diet. Although children with the disease also need to drink plenty of fluids, care should be taken to monitor sodium intake in their fluids.

What is the long-term outlook for children with diabetes insipidus?

Diabetes insipidus can be a temporary or a permanent condition, depending on what is causing the disease. Children with central diabetes insipidus, with proper management, can lead full, healthy lives. Children with nephrogenic diabetes insipidus can also lead relatively normal lives with proper medical care and management, especially if the medical care is started early.