Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300

mOsm/kg). It has the following 2 major forms:

Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased

secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP])

Nephrogenic DI, characterized by decreased ability to concentrate urine because of

resistance to ADH action in the kidney [1]
Two other forms are gestational DI and primary polydipsia (dipsogenic DI); both are caused by
deficiencies in AVP, but the deficiencies do not result from a defect in the neurohypophysis or
kidneys.

Signs and symptoms

The predominant manifestations of DI are as follows:

Polyuria: The daily urine volume is relatively constant for each patient but is highly variable
between patients (3-20 L)

Polydipsia

Nocturia
The most common form is central DI after trauma or surgery to the region of the pituitary and
hypothalamus, which may exhibit 1 of the following 3 patterns:

Transient
Permanent
Triphasic (observed more often clinically)
In infants with DI, the most apparent signs may be the following:

Crying
Irritability
Growth retardation
Hyperthermia
Weight loss
In children, the following manifestations typically predominate:

Enuresis
Anorexia
Linear growth defects
Fatigability