Abstract
The delicate balance of water homeostasis and osmolality of body fluids in man is regulated by antidiuretic hormone (ADH) secreted from the posterior pituitary. Inadequate secretion or inappropriate peripheral action of ADH leads to diabetes insipidus (DI). Patients present with polyuria and polydipsia. Biochemically they have hyperosmolar plasma and hypoosmolar urine. The water deprivation test is an established test to differentiate between cranial and renal DI. Psychological conditions such as primary polydipsia have to be considered while evaluating patients with polyuria and polydipsia. Metabolic conditions such as diabetes mellitus and electrolyte abnormalities such as hypokalaemia and hypercalcaemia can cause similar symptoms. Synthetic ADH still remains the treatment of choice for cranial DI. Drugs are the most common cause of renal DI. In renal DI, the primary aim should be to treat the underlying abnormality such as correction of electrolyte abnormalities or withdrawal of offending drugs.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Thrasher T. Baroreceptor regulation of vasopressin and renin secretion: low-pressure versus high-pressure receptors. Front Neuroendocrinol. 1994;15(2):157–96.
Bourque CW. Central mechanisms of osmosensation and systemic osmoregulation. Nat Rev Neurosci. 2008;9:519–31. doi:10.1038/nrn2400.
Lechner SG, Markworth S, Poole K, Smith ES, Lapatsina L, Frahm S, et al. The molecular and cellular identity of peripheral osmoreceptors. Neuron. 2011;69:332–44. doi:10.1016/j.neuron.2010.12.028.
Brown D. The ins and outs of aquaporin-2 trafficking. Am J Physiol Renal Physiol. 2003;284(5):893–901.
Verbalis J, Robinson A, Moses M. Postoperative and post traumatic diabetes insipidus. In: Czernichow P, Robinson A, editors. Diabetes insipidus in man. Basel: Karger; 1985. p. 247–67.
Robertson G. Diabetes insipidus. Endocrinol Metab Clin North Am. 1995;24(3):549–72.
Robinson A, Verbalis J. Diabetes insipidus. Curr Ther Endocrinol Metab. 1997;6:1–7.
Richardson D, Robinson A. Desmopressin. Ann Intern Med. 1985;103(2):228–39.
Lam K, Wat M, Choi K, Pang RWC, Ip TP, Kumana CR. Pharmacokinetics, pharmacodynamics, long-term efficacy and safety of oral 1-deamino-8-d-arginine vasopressin in adult patients with central diabetes insipidus. Br J Clin Pharmacol. 1996;42(3):379–85.
Pokracki F, Robinson A, Seif S. Chlorpropamide effect: measurement of neurophysin and vasopressin in humans and rats. Metabolism. 1981;30(1):72–8.
Knoers NV, Deen PM. Molecular and cellular defects in nephrogenic diabetes insipidus. Pediatr Nephrol. 2001;16:1146–52.
Nguyen MK, Nielsen S, Kurtz I. Molecular pathogenesis of nephrogenic diabetes insipidus. Clin Exp Nephrol. 2003;7(1):9–17.
Nielson S, Frokiaer J, Marples D, Kwon TH, Agre P, Knepper MA. Aquaporins in the kidney: from molecules to medicine. Physiol Rev. 2002;82(1):205–44.
Marples D, Frokiaer J, Knepper M, Nielsen S. Disordered water channel expression and distribution in acquired nephrogenic diabetes insipidus. Proc Assoc Am Physicians. 1998;110(5):401–6.
Kim G-H, Lee JW, Oh YK, Chang HR, Joo KW, Na KY, et al. Antidiuretic effect of hydrochlorothiazide in lithium-induced nephrogenic diabetes insipidus is associated with up regulation of aquaporin-2, Na-Cl cotransporter and epithelial sodium channel. J Am Soc Nephrol. 2004;15:2836–43.
Hochberg Z, Even L, Danon A. Amelioration of polyuria in nephrogenic diabetes insipidus due to aquaporin-2 deficiency. Clin Endocrinol (Oxf). 1998;49(1):39–44.
Kruse D, Pantelis C, Rudd R, Quek J, Herbert P, McKinley M. Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan). Aust N Z J Psychiatry. 2001;35(1):65–8.
Sklar AH, Schrier RW. Central nervous system mediators of vasopressin release. Physiol Rev. 1983;63(4):1243–80.
Kishy T, Kurosawa H, Endo S. Is propranolol effective in primary polydipsia? Int J Psychiatry Med. 1998;28:315–25.
Sebastian CS, Bernardin AS. Comparison of enalapril and captopril in the management of self-induced water intoxication. Biol Psychiatry. 1990;27(7):787–90.
Robertson GL, Mahr EA, Athar S, Sinha T. Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma. J Clin Invest. 1973;52:2340–52.
Preibisz JJ, Sealey JE, Laragh JH, Cody RJ, Weksler BB. Plasma and platelet vasopressin in essential hypertension and congestive heart failure. Hypertension. 1983;5(2 Part 2):I129–38.
Kluge M, Riedl S, Erhart-Hofmann B, Hartmann J, Waldhauser F. Improved extraction procedure and RIA for determination of arginine8-vasopressin in plasma: role of premeasurement sample treatment and reference values in children. Clin Chem. 1999;45:98–103.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag London
About this chapter
Cite this chapter
Chandrajay, D., Barth, J.H. (2015). Polyuria and Polydipsia. In: Ajjan, R., Orme, S. (eds) Endocrinology and Diabetes. Springer, London. https://doi.org/10.1007/978-1-4471-2789-5_10
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2789-5_10
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2788-8
Online ISBN: 978-1-4471-2789-5
eBook Packages: MedicineMedicine (R0)