Neuroimaging of central diabetes insipidus—when, how and findings

Abstract

Central or neurogenic diabetes insipidus (CDI) is due to deficient synthesis or secretion of antidiuretic hormone (ADH), also known as arginine vasopressin peptide (AVP). It is clinically characterised by polydipsia and polyuria (urine output > 30 mL/kg/day) of dilute urine (< 250 mOsm/L). It is the result of a defect in one of more sites involving the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei of the hypothalamus, median eminence of the hypothalamus, infundibulum or the posterior pituitary gland. A focused MRI pituitary gland or sella protocol is essential. There are several neuroimaging correlates and causes of CDI, illustrated in this review. The most common causes are benign or malignant neoplasms of the hypothalamic-pituitary axis (25%), surgery (20%), head trauma (16%) or familial causes (10%). No cause is identified in up to 30% of cases. Knowledge of the anatomy and physiology of the hypothalamo-neurohypophyseal axis is crucial when evaluating a patient with CDI. Establishing the aetiology of CDI with MRI in combination with clinical and biochemical assessment facilitates appropriate targeted treatment. The aim of the pictorial review is to illustrate the wide variety of causes of CDI on neuroimaging, highlight the optimal MRI protocol and to revise the detailed neuroanatomy and neurophysiology required to interpret these studies.

Permanent central diabetes insipidus after mild head injury

“…Absence of PPBS in the absence of known hypothalamic–pituitary dysfunction can also be seen up to 20%–30% of normal population, especially in older individuals. Thus, the absence of PPBS is significant in central DI only in the correct clinical settings 11. In our brain imaging tests, CT did not show any abnormalities, and MRI findings were in support with the diagnosis of posterior pituitary dysfunction as it lacked the neurohypophyseal hyperintensity on T1 weighted images.…”

Endoplasmic reticulum stress induces apoptosis of arginine vasopressin neurons in central diabetes insipidus via PI3K/Akt pathway

“…Any injury of HNS could lead to dysfunction of the whole body and even result in severe diseases. Hypothalamic injury caused by trauma, tumor, or surgery around pituitary stalk serves as the common reasons of imbalance of HNS …”

“…Hypothalamic injury caused by trauma, tumor, or surgery around pituitary stalk serves as the common reasons of imbalance of HNS. 24,25 Central diabetes insipidus usually occurs as a result of the disturbance of the HNS, especially when pituitary stalk is implicated during tumor resection surgery or other operations near the hypothalamus. 21 Typically, CDI can be separated into three distinct , and NAC (7 days) +PEL (N = 3) by Western blot, respectively.…”

Lateral fluid-percussion injury leads to pituitary atrophy in rats

“…The neurohypophysis receives projections from the paraventricular and supraoptic nuclei of the hypothalamus, and the role of this axis in the regulation of systemic release of oxytocin and vasopressin is well established, in rodents and humans 11 . In humans, a defect in the components of the hypothalamo-neurohypophyseal axis may lead to the development of diabetes insipidus (DI), which is characterized by polydipsia, polyuria, dehydration and hyponatremia 11,34 . Moreover, lesions of hypothalamo-neurohypophyseal axis account for 25% cases of DI in humans and DI occurs in 2.9% of TBI admitted to the intensive care unit 34 .…”