Diabetes Insipidus in Children
Diabetes insipidus (DI) is a
condition caused by not enough antidiuretic hormone (ADH) in the body. ADH is also
as vasopressin. This is a hormone that helps the kidneys keep the correct amount of
water in the body. The condition is also called “water diabetes.” This is because
with diabetes, ADH deficiency results in large volumes of urine. But unlike with
diabetes mellitus, the frequent urination is not from high blood sugar.
ADH controls how much water is in
urine that the kidneys make. ADH is secreted by a small gland at the base of the brain
called the hypothalamus. It’s stored in the pituitary gland and then released into
bloodstream when needed. ADH lowers the amount of water the kidneys make into urine.
This helps prevent dehydration. With diabetes insipidus, too much water is pulled
the blood by the kidneys. This causes the body to create a lot of watery urine and
to thirst. ADH also affects the concentration of sodium in the blood. When ADH is
isn't working correctly, sodium concentration increases. This is responsible for some
symptoms of DI.
The disease has 4 types:
Central diabetes insipidus. With this type, not enough ADH
is made or secreted. This is most often because of damage to the hypothalamus
or pituitary gland. Typical causes include injury to the brain, tumor, and rare
Nephrogenic diabetes insipidus. With this type, the
kidneys don’t respond normally to ADH. This is most often because of medicines or
chronic disorders. Some genetic disorders can affect the kidneys from birth. Other
causes of kidney problems include kidney failure, sickle cell disease, and polycystic
Dipsogenic diabetes insipidus. This is caused by a problem
with your child's sense of thirst. It causes your child to be abnormally thirsty and
drink a lot. Your child then makes more urine.
Gestational diabetes insipidus. This occurs only during
pregnancy and usually goes away after your baby is born. It may come back if you have
Diabetes insipidus can be caused by
conditions, such as:
- A hypothalamus gland that doesn’t make
- A pituitary gland that doesn’t release
enough ADH into the blood
- Damage to the hypothalamus or
pituitary gland during surgery or radiation therapy
- Brain injury
- Brain tumor
- Blockage in the arteries leading to
- Inflammation of the brain
(encephalitis) or the membranes that cover the brain and spinal cord
- Family heredity
- Certain medicines, such as
A child is more likely to get diabetes insipidus if they have a head
injury, brain surgery, a brain tumor, kidney disease, or use certain medicines, such
Symptoms can occur a bit differently in each child. They can include:
- More thirst than normal
- More urination than normal or
- Dehydration or weight loss
Babies with diabetes insipidus may
show signs, such as:
- Poor feeding
- Failure to grow
- High fevers
The symptoms of diabetes insipidus
can be like other health conditions, such as diabetes mellitus. Make sure your child
sees their healthcare provider for a diagnosis.
The healthcare provider will ask
about your child’s symptoms and health history. They may also ask about your family’s
health history. The healthcare provider may ask you about your child’s daily fluid
intake, diet, and bowel and bladder habits. Your child will have a physical exam.
child may also have tests, such as:
Urine tests. A single urine specimen may be used to check
if the urine is diluted or concentrated. A child may need to collect urine over 24
hours to check for the amount of urine they make in a day.
Blood test. This is done to measure salt (sodium) levels
in the blood.
Water deprivation test. This test is done in the hospital.
It checks if dehydration occurs while a child doesn’t eat or drink.
MRI of the pituitary. This test uses large magnets and a
computer to make detailed images of tissues in the body without the use of X-ray.
test is done to look for problems with the hypothalamus or pituitary gland.
Treatment depends on the cause.
Treating the cause usually treats the diabetes insipidus.
Treatment may be done with
synthetic ADH. This may be taken as a pill, injection, or nasal spray.
Your child must also drink plenty
of fluids. This is to make up for the amount of fluids lost by the body through excess
urine and to protect your child from dehydration. You may need to watch your child’s
fluid intake and urine output. Your child's healthcare provider will check the amount
sodium in your child's blood often to make sure the medicine dose is correct.
If left untreated, diabetes
insipidus can lead to problems in a child, such as:
- Brain damage
- Impaired mental function
- Short attention span
- Poor growth
Diabetes insipidus can be temporary or permanent. It depends on what
is causing the disease. By managing the condition, a child with central diabetes
insipidus can lead a full, healthy life. A child with nephrogenic diabetes insipidus
lead a relatively normal life with correct medical care, especially if the medical
is started early. Work with your child's healthcare providers to create an ongoing
to manage your child’s condition.
When to Call a Healthcare Provider
Talk with your child's healthcare provider if your child drinks and urinates a lot.
- Diabetes insipidus is a condition caused by not enough antidiuretic hormone (ADH)
in the body. This is a hormone that helps the kidneys keep the correct amount of water
in the body.
- ADH lowers the amount of water the kidneys make into urine. This helps prevent dehydration.
With diabetes insipidus, too much water is pulled from the blood by the kidneys. This
causes the body to create a lot of watery urine, and leads to thirst.
- The diabetes insipidus has 4 types:
central, nephrogenic, dipsogenic, and gestational. Each type acts differently, and
each has different causes.
- Symptoms can include excessive thirst and urination.
- Your child may have a urine test, blood test, and a water deprivation test.
- Treatment may be done with synthetic
ADH. This may be taken as a pill, shot (injection), or nasal spray. Other treatments
include medicines that help the body make ADH or use it better.
- If left untreated, diabetes insipidus
can lead to problems in a child, such as brain damage, excess of sodium, and poor
- With treatment, a child with diabetes insipidus can lead a full, healthy life.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.