Central Diabetes Insipidus

by Carlo Raj, MD

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    Let’s talk about central diabetes insipidus. What’s my problem? I don’t have enough ADH, I just don’t. What happened? Before we get there, urine osmolality - low; plasma osmolality - high; ADH level - decreased; receptor activity – well, even if the receptors are perfectly normal, which they are in central, it does not matter, the patient does not have ADH. May follow head injury, now, be very careful here. We talk about head injury. That’s interesting, right? You would think-You would think by having head injury that you would lose ADH, that’s a possibility. Or what if there is head injury and initially, you may actually release too much ADH? “So, Dr. Raj, you’re telling me both instances are possible?” That’s exactly what I’m telling you. We see… we’re going to see this concept again in thyroid disorder. In thyroid gland, with the colloid, initially when you destroy it, you might have too much T3, T4, as we shall see. Okay. So, with head injury, the trauma depletes the posterior pituitary gland of ADH stores. Sure, that could happen. Posterior pituitary, it cannot-it cannot properly secrete your ADH, your patient is central diabetes insipidus, but the receptors? Perfectly normal, keep that in mind because that’s important for us to manage your patient. Because circulating levels of ADH are low, the entire DT/CD, by that we mean distal convoluted tubule and collecting duct are impermeable to water. So, what kind of urine are you producing? Good, diluted urine. What’s my plasma osmolality? Increased. Large volume, polyuria, look how much urine you’re losing per day, 15 litres per day, that’s amazing. So, what’s your next step of management? IV fluids, but “Dr. Raj, I’m already losing water.” Correct, you are, but my goodness gracious, you’re losing 15 litres of water per...

    About the Lecture

    The lecture Central Diabetes Insipidus by Carlo Raj, MD is from the course Pituitary Gland Disorders.

    Included Quiz Questions

    1. Normal functioning posterior pituitary
    2. Normal ADH receptors
    3. Low or no circulating ADH
    4. Distal tubule and collecting ducts are impermeable to water
    5. Large volume of dilute urine
    1. Stimulates ADH receptors
    2. Decreases circulating ADH levels
    3. Stimulates posterior pituitary
    4. Increases plasma osmolarity
    5. Stimulates vasodilation
    1. Idiopathic/autoimmune
    2. Head trauma
    3. Congenital hypopituitarism
    4. Wolfram syndrome
    5. Tumor
    1. Edema
    2. Polyuria
    3. Nocturia
    4. Polydipsia
    5. Altered mental status
    1. Polyuric phase- ADH phase- permanent CDI/ADH depletion
    2. ADH depletion- polyuric phase- ADH phase
    3. ADH phase- polyuric phase- permanent CDI/ADH depletion
    4. Polyuric phase- ADH depletion- ADH phase
    5. ADH depletion- polyuric phase- permanent CDI

    Author of lecture Central Diabetes Insipidus

     Carlo Raj, MD

    Carlo Raj, MD

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    good explanation ye ye ye ye ye ye ye ye ye ye
    By pushpinder b. on 26. February 2017 for Central Diabetes Insipidus

    good explanation ye ye ye ye ye ye ye ye ye ye