Diabetes insipidus--diagnosis and management

Horm Res Paediatr. 2012;77(2):69-84. doi: 10.1159/000336333. Epub 2012 Mar 16.


Central diabetes insipidus (CDI) is the end result of a number of conditions that affect the hypothalamic-neurohypophyseal system. The known causes include germinoma/craniopharyngioma, Langerhans cell histiocytosis (LCH), local inflammatory, autoimmune or vascular diseases, trauma resulting from surgery or an accident, sarcoidosis, metastases and midline cerebral and cranial malformations. In rare cases, the underlying cause can be genetic defects in vasopressin synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits. The diagnosis of the underlying condition is challenging and raises several concerns for patients and parents as it requires long-term follow-up. Proper etiological diagnosis can be achieved via a series of steps that start with clinical observations and then progress to more sophisticated tools. Specifically, MRI identification of pituitary hyperintensity in the posterior part of the sella, now considered a clear marker of neurohypophyseal functional integrity, together with the careful analysis of pituitary stalk shape and size, have provided the most striking findings contributing to the diagnosis and understanding of some forms of 'idiopathic' CDI. MRI STIR (short-inversion-time inversion recovery sequencing) is a promising technology for the early identification of LCH-dependent CDI.

Publication types

  • Review

MeSH terms

  • Adult
  • Age Factors
  • Animals
  • Antidiuretic Agents / administration & dosage
  • Antidiuretic Agents / adverse effects
  • Antidiuretic Agents / therapeutic use
  • Child
  • Deamino Arginine Vasopressin / administration & dosage
  • Deamino Arginine Vasopressin / adverse effects
  • Deamino Arginine Vasopressin / therapeutic use
  • Diabetes Insipidus / diagnosis*
  • Diabetes Insipidus / etiology
  • Diabetes Insipidus / genetics
  • Diabetes Insipidus / therapy*
  • Diabetes Insipidus, Nephrogenic / diagnosis
  • Diabetes Insipidus, Nephrogenic / etiology
  • Diabetes Insipidus, Nephrogenic / genetics
  • Diabetes Insipidus, Nephrogenic / therapy
  • Diabetes Insipidus, Neurogenic / diagnosis
  • Diabetes Insipidus, Neurogenic / etiology
  • Diabetes Insipidus, Neurogenic / genetics
  • Diabetes Insipidus, Neurogenic / therapy
  • Drug Monitoring
  • Fluid Therapy
  • Humans
  • Infant


  • Antidiuretic Agents
  • Deamino Arginine Vasopressin