Ever drink a lot and still feel thirsty? Or wake up multiple times at night to pee? Those are classic red flags for central (cranial) diabetes insipidus, a condition where your body can’t hold on to water because it lacks the hormone that tells your kidneys to conserve it.
Central diabetes insipidus (CDI) happens when the pituitary gland or hypothalamus doesn’t release enough antidiuretic hormone (ADH, also called vasopressin). Without ADH, your kidneys make large amounts of very dilute urine and you feel an intense, constant thirst. Left unchecked, this can lead to dehydration and high sodium levels in the blood.
Causes vary. The usual culprits are head injury, brain surgery (especially near the pituitary), tumors like craniopharyngioma, infections (meningitis), or autoimmune damage. Sometimes doctors can’t find a cause; that’s called idiopathic CDI.
Watch for these signs: passing unusually large volumes of urine (often several liters daily), very strong thirst, waking at night to urinate, dry mouth, and lightheadedness. In severe cases you may get confusion, muscle weakness, or seizures from high blood sodium.
Your doctor will check urine color, measure how much you pee, and run labs: urine osmolality (how concentrated your urine is) and blood sodium. Low urine osmolality with high or normal blood sodium suggests diabetes insipidus. The water deprivation test is a standard but careful test to see if urine concentrates when you stop drinking fluids. Newer tests measure copeptin, a stable marker linked to ADH, and an MRI can check the pituitary for injury, tumors, or inflammation.
It’s also important to tell the difference between central and nephrogenic diabetes insipidus. In nephrogenic DI the kidneys don’t respond to ADH, so treatment differs.
Treatment aims to replace ADH and fix the cause if possible. Desmopressin (DDAVP) is the main medicine — it mimics ADH and cuts urine output while easing thirst. It comes as a nasal spray, tablet, or injection. Dosage is tailored to your needs, and your doctor will monitor blood sodium to avoid water overload and low sodium (hyponatremia).
If CDI comes from a tumor, infection, or surgery, treating that underlying issue may improve or cure the DI. For temporary cases after surgery or head injury, desmopressin may be needed only short-term.
Practical tips: measure how much you drink and pee for a few days before your appointment, carry a note about your condition and meds, and check sodium if you’re sick or vomiting. Be cautious with fluid intake once on desmopressin — follow dosing guidance so you don’t drink too much and dilute your blood.
If you have sudden extreme thirst, very little urine, dizziness, confusion, or signs of severe dehydration, seek urgent care. Talk to your healthcare team about long-term follow-up, dose adjustments, and when to repeat imaging or labs. With proper diagnosis and treatment, most people with central diabetes insipidus can manage symptoms and stay safe.
In my recent deep dive into medical research, I discovered a fascinating link between Central Cranial Diabetes Insipidus and thyroid disorders. It seems that these two conditions can often occur together, though the exact reason behind their connection remains unclear. This coexistence can complicate the diagnosis and treatment of both conditions. It's crucial for healthcare professionals to be aware of this connection to manage both disorders effectively. So, for those grappling with either condition, it may be worth discussing this potential link with your healthcare provider.