All of the following conditions are known to cause diabetes insipidus, except –
Correct Answer: Multiple sclerosis
Description: Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst.[The amount of urine produced can be nearly 20 liters per day.[Reduction of fluid has little effect on the concentration of the urine.Complications may include dehydration or seizures Nephrogenic diabetes insipidus is due to the inability of the kidney to respond normally to vasopressin. Dipsogenic Dipsogenic DI or primary polydipsia results from excessive intake of fluids as opposed to deficiency of arginine vasopressin. It may be due to a defect or damage to the thirst mechanism, located in the hypothalamus, or due to mental illness. Treatment with desmopressin may lead to water intoxication. Gestational Gestational DI occurs only during pregnancy and the postpaum period. During pregnancy, women produce vasopressinase in the placenta, which breaks down antidiuretic hormone (ADH). Gestational DI is thought to occur with excessive production and/or impaired clearance of vasopressinase. Most cases of gestational DI can be treated with desmopressin (DDAVP), but not vasopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used. Diabetes insipidus is also associated with some serious diseases of pregnancy, including pre-eclampsia, HELLP syndrome and acute fatty liver of pregnancy. These cause DI by impairing hepatic clearance of circulating vasopressinase. It is impoant to consider these diseases if a woman presents with diabetes insipidus in pregnancy, because their treatments require delivery of the baby before the disease will improve. Failure to treat these diseases promptly can lead to maternal or perinatal moality. Ref Davidson edition23rd pg 887
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