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Aetiology

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About 30% of cases are idiopathic. Other common causes are head injury - 30% of cases - and pituitary tumours.

Familial - extremely uncommon:

  • dominant inheritance
  • associated with diabetes mellitus, optic atrophy, nerve deafness, atonia of bladder

Acquired:

  • idiopathic - a third of cases show an autoimmune basis with circulating antibodies to hypothalamic neurons, not to circulating ADH
  • head injury and neurosurgery
  • neoplastic - pituitary tumour, craniopharyngioma, dysgerminoma, hypothalamic metastases - often in children
  • infectious - meningitis, encephalitis
  • granulomatous disease - sarcoidosis, histiocytosis
  • vascular - aneurysm, sickle cell anaemia, Sheehan's syndrome
  • drugs - ADH secretion is suppressed by naloxone, ethanol and phenytoin

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