What is the treatment of choice for central diabetes insipidus?

The treatment of choice for central diabetes insipidus is desmopressin. Central diabetes insipidus occurs due to insufficient production of antidiuretic hormone (ADH) from the posterior pituitary gland, leading to the kidneys being unable to concentrate urine and excessive urination. Desmopressin is a synthetic analog of ADH that acts on the kidneys to promote water reabsorption, thereby reducing urine output and mitigating the symptoms of central diabetes insipidus.

Desmopressin effectively increases the permeability of the renal collecting ducts to water, allowing for improved water reabsorption and concentration of urine. This results in a significant decrease in daily urine output and helps to prevent dehydration in affected patients. The specificity of desmopressin for V2 receptors in the kidneys enhances its therapeutic action while minimizing side effects that could occur with other treatments.

Other treatments listed, such as hydrochlorothiazide, indomethacin, and amiloride, may have roles in managing nephrogenic diabetes insipidus or might assist in unique situations, but they are not the primary treatment for central diabetes insipidus. Hydrochlorothiazide, for example, is sometimes used off-label to reduce urine output in nephrogen