Issues of differential diagnosis and management of central diabetes insipidus / differential diagnosis and management of central diabetes insipidus

Diabetes insipidus (DI) is a syndrome characterized by the excretion of abnormally large volumes of diluted urine. It can be caused by two fundamentally different defects that must be distinguished for safe and effective management. First: central DI, due to inadequate production/secretion of vasopressin (AVP) and nephrogenic DI, due to renal insensitivity to AVP. Second: primary polydipsia, due to suppression of AVP secretion by excessive fluid intake. This review provides methods of differential diagnosis of DI. The article highlights the availability of functional tests and pituitary MRI in correct diagnosis of central DI. Common treatment algorithms of DI and management of DI in the neurosurgical patients are also discussed. The article provides comparative data of the efficacy and safety of various pharmacological forms of desmopressin in the treatment of central DI.