Current perspective on the pathogenesis of central diabetes insipidus.
Diabetes insipidus is a heterogeneous condition characterised by polyuria and polydipsia caused by a lack of secretion of vasopressin, its physiological suppression following excessive water intake, or kidney resistance to its action. The clinical and laboratory diagnosis is confirmed by standard tests, but recent advances in molecular biology and imaging techniques have shed new light on the pathophysiology of this disease. In many patients, central diabetes insipidus is caused by a germinoma or craniopharyngioma; Langerhans' cell histiocytosis and sarcoidosis of the central nervous system; local inflammatory, autoimmune or vascular diseases; trauma from surgery or accident; and, rarely, genetic defects in vasopressin biosynthesis inherited as autosomal dominant or X-linked recessive traits. Thirty to fifty percent of cases are considered idiopathic. Tumour-associated central diabetes insipidus is uncommon in children younger than 5 years old. Biopsy of enlarged pituitary stalk should be reserved for patients with hypothalamic-pituitary mass and progressive thickening of the pituitary stalk since spontaneous recovery may occur. Molecular biology in selected patients may identify those with apparently idiopathic diabetes insipidus carrying the vasopressin-neurophysin II gene mutation.
Ghirardello
Stefano
S
Department of Pediatrics, IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy.
Malattia
Clara
C
Scagnelli
Paola
P
Maghnie
Mohamad
M
D001327:Autoimmune Diseases / Q000150:complications; D001932:Brain Neoplasms / Q000150:complications; D002648:Child; D020790:Diabetes Insipidus, Neurogenic / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D018237:Germinoma / Q000150:complications; D006801:Humans; D009481:Neurophysins / Q000235:genetics; D014667:Vasopressins / Q000235:genetics
D009481:Neurophysins; D014667:Vasopressins