Clinical and Experimental Nephrology

, Volume 10, Issue 1, pp 63–67 | Cite as

Dipsogenic diabetes insipidus: report of a novel treatment strategy and literature review

  • Robert M. Perkins
  • Christina M. Yuan
  • Paul G. Welch


Dipsogenic diabetes insipidus is a syndrome of disordered thirst, in patients without psychiatric disease, which may be confused with partial central diabetes insipidus. Distinguishing these entities involves monitored water testing. Therapy with antidiuretic hormone in patients with dipsogenic diabetes insipidus is thought to be contraindicated for fear of inducing water intoxication. We report a case of a 26-year-old woman without psychiatric illness referred for longstanding polyuria and polydipsia. Otherwise healthy, she complained of near-constant thirst and frequent urination, causing severe disruption of her personal and professional life. She had been consistently eunatremic and polyuric, with low urine osmolality. Results of extensive water testing revealed intact urinary concentrating and diluting capacity, physiologic though blunted antidiuretic hormone (ADH) release, and an abnormally low thirst threshold, consistent with the diagnosis of dipsogenic diabetes insipidus. To control her polyuria we initiated treatment with intermittent, low-dose, intranasal desmopressin and strict water restriction during drug dosing. In follow-up she reported excellent control of polyuria and significant functional improvement. The reviewed literature demonstrates a limited number of reports about dipsogenic diabetes insipidus, and no prior report of a similar treatment strategy. Dipsogenic diabetes insipidus is an uncommonly (and not universally) recognized disorder, requiring monitored testing in order to distinguish it from incomplete forms of central diabetes insipidus. Though therapy with desmopressin cannot be recommended based on the results of a single case, the outcome presented here is intriguing and suggests that larger studies in such patients is warranted to assess the broader application of such an intervention.

Key words

Dipsogenic diabetes insipidus Partial central diabetes insipidus Polydipsia Polyuria Water restriction 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Robertson, G 1987Dipsogenic diabetes insipidus: a newly recognized syndrome caused by a selective defect in the osmoregulation of thirstTrans Assoc Am Physicians1002419PubMedGoogle Scholar
  2. 2.
    Baylis, P, Cheetham, T 1998Diabetes insipidusArch Dis Child79849PubMedGoogle Scholar
  3. 3.
    Miller, M, Kalkos, T, Moses, A 1970Recognition of partial defects in antidiuretic hormone secretionAnn Intern Med737219PubMedGoogle Scholar
  4. 4.
    Zerbe, R, Robertson, G 1981A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuriaN Engl J Med305153946PubMedGoogle Scholar
  5. 5.
    Moses, A, Clayton, B 1993Impairment of osmotically stimulated AVP release in patients with primary polydipsiaAm J Physiol265R124752PubMedGoogle Scholar
  6. 6.
    Kathol, R, Wilcox, J, Turner, R, Kronfol, Z, Olson, S 1986Pharmacologic approaches to psychogenic polydipsiaProg Neuropsychopharmacol Biol Psychiatry1095100CrossRefPubMedGoogle Scholar
  7. 7.
    Brooks, G, Ahmed, A 2002Pharmacologic treatments for psychosis-related polydipsiaCochrane database of systematic reviews3CD003544Google Scholar
  8. 8.
    Skowsky, W, Rosenbloom, A, Fisher, D 1974Radioimmunoassay measurement of arginine vasopressin in serum: development and applicationJ Clin Endocrinol Metab3827886PubMedGoogle Scholar
  9. 9.
    Rose, B, Post, T 2001Clinical physiology of acid-base and electrolyte disorders5th ed.McGraw-HillNew York771Google Scholar
  10. 10.
    Thompson, C, Bland, J, Burd, J, Baylis, P 1986The osmotic thresholds for thirst and vasopressin release are similar in healthy manClin Sci716516PubMedGoogle Scholar
  11. 11.
    Wolf, A 1950Osmometric analysis of thirst in man and dogAm J Physiol1617586PubMedGoogle Scholar
  12. 12.
    Baylis, P, Robertson, G 1980Plasma vasopressin response to hypertonic saline infusion to assess posterior pituitary functionJ R Soc Med7325560PubMedGoogle Scholar
  13. 13.
    Seckl, J, Williams, T, Lightman, S 1986Oral hypertonic saline causes transient fall of vasopressin in humansAm J Physiol251R2148PubMedGoogle Scholar
  14. 14.
    Mellinger, R, Zafar, M 1983Primary polydipsia: syndrome of inappropriate thirstArch Intern Med143124951CrossRefPubMedGoogle Scholar
  15. 15.
    Ferrer, J, Helperin, J, Conget, J, Cabrer, E, Esmatjes, , Vilardell, E 1990Acute water intoxication after intranasal desmopressin in a patient with primary polydipsiaJ Endocrinol Invest136636PubMedGoogle Scholar
  16. 16.
    Maghnie, M, Cosi, G, Genovese, E, Manca-Bitti, M, Cohen, A, Zecca, S,  et al. 2000Central diabetes insipidus in children and young adultsN Engl J Med3439981007CrossRefPubMedGoogle Scholar
  17. 17.
    Robertson, G 1995Diabetes insipidusEndocrinol Clin N Am2454972Google Scholar

Copyright information

© Japanese Society of Nephrology 2006

Authors and Affiliations

  • Robert M. Perkins
    • 1
  • Christina M. Yuan
    • 1
  • Paul G. Welch
    • 2
  1. 1.Department of Medicine/Nephrology ServiceWalter Reed Army Medical CenterWashington, DCUSA
  2. 2.West Virginia University Health Sciences CenterDorothy McCormack CenterMartinsburgUSA

Personalised recommendations