What are the patterns of central diabetes insipidus (DI)?

Updated: Mar 18, 2020
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

A patient’s history may indicate whether he/she has central or nephrogenic DI. The most common form of DI is central DI following 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. Whether improvements in surgical techniques and approaches have altered the frequency of the triphasic pattern is not well studied.

The first phase of the triphasic pattern 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 urinary osmolality occur. The second phase is an antidiuretic one that lasts 5-6 days, resulting from the release of stored hormone; urinary osmolality rises. The third phase can be permanent DI, when stores of ADH are exhausted and the cells that produce ADH are absent or unable to produce more.


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