What Is Diabetes insipidus
Diabetes insipidus (diabetes insipidus, diabetes insipidus syndrome) is a disorder in the secretion or production of an antidiuretic hormone that causes polyuria (urinary incontinence) and polydipsia (severe thirst).
Vasopressin acts on the kidneys and reabsorbs water into the bloodstream, preventing excess water in the urine.
With diabetes insipidus, there is a decrease in production or insufficient effect of the antidiuretic hormone on the kidneys, causing a large amount of water to be lost in the urine. As a result, patients develop dehydration and excessive thirst.
Causes of Diabetes Insipidus
Diabetes insipidus is a pathology caused by vasopressin deficiency, its complete or relative deficiency. Vasopressin (antidiuretic hormone) is secreted in the hypothalamus and, among other functions, is responsible for normalizing the urinary process. Accordingly, it is customary to distinguish three types of this disease by the causes of origin: genetic, acquired, idiopathic.
Many patients with this rare disease still do not know the causes of its occurrence. Such diabetes insipidus is called idiopathic and 70% of patients suffer from it. Genetic diabetes is caused by a genetic factor called insipidus. In this case, it can be in several family members or in several generations in a row.
Modern medicine describes this pathology through drastic changes in the genotype that lead to dysfunction of the antidiuretic hormone. The pathogenesis of this pathology is due to a congenital defect in the structure of the midbrain and dynesphalon.
Considering the causes of diabetes insipidus, it is necessary to consider the mechanisms by which it occurs.
Central diabetes insipidus - caused by insufficient secretion of vasopressin in the hypothalamus or violation of its secretion into the blood from the pituitary gland, possibly due to:
Deficiency in the hypothalamus, which regulates the excretion of urine and the production of antidiuretic hormone, a violation of its function can provoke the occurrence of this disease. Provocative factors and causes of dysfunction of the hypothalamus Acute and chronic infections: tuberculosis, sexually transmitted diseases, flu, tonsillitis.
Concussion, traumatic brain injury.
Cystic, degenerative, inflammatory lesions of the kidneys impair the perception of vasopressin.
Tumor processes of the hypothalamus and pituitary gland.
Also, diabetes exacerbates the presence of hypertension during insipidus.
Vascular injuries of the hypothalamic-pituitary system can lead to cerebral circulation problems in the vessels that feed the hypothalamus and pituitary gland.
Kidney diabetes insipidus means that vasopressin is produced in sufficient quantities, but the kidney tissue does not respond properly to it. The reasons for this situation may be as follows:
Drop-in increased potassium or blood calcium+
Chronic renal failure
Amyloidosis (amyloid deposition in tissues) or polycystic of the kidneys (multiple cyst formation);
Damage to the urinary tract of the kidney nephron or medulla.
Hereditary factor - congenital pathology.
Taking drugs that are toxic to kidney tissue ("demeclocycline", "amphotericin B". "lithium").
Sometimes the pathology occurs in old age or in the context of another pathology weakening.
In the context of stress, in some cases, thirst (psychogenic polydipsia) develops. Also, there may be diabetes insipidus in the third trimester of pregnancy, when vasopressin is destroyed by specific enzymes secreted by the placenta. Both types of violations are eliminated independently after the root cause is removed.
Signs of Diabetes Insipidus
The disease develops equally in women and men regardless of age, but most often within 20-40 years. The severity of the pathology signs depends on the degree of vasopressin deficiency. As the hormone is low, the symptomatology cannot be pronounced or eliminated. In some cases, the first symptoms of this pathology appear in people with alcoholism - trips, trips, trips while taking corticosteroids.
It is difficult to observe the onset of this type of diabetes because the volume of urine on a daily basis increases significantly. This symptom is called polyuria and can have varying degrees of severity. Most often, the urine is colorless, free of salts and other elements. With the development of this type of dehydration, the body needs to replenish the fluid it has lost.
Accordingly, for diabetes insipidus, polydipsia or undetectable thirst is a hallmark symptom. Frequent urge to urinate can cause a sick person to drink large amounts of fluid. As a result, there is a significant increase in the size of the bladder. The symptoms of this pathology can cause a person a lot of anxiety, so in most cases, it is not too late to visit a doctor. Patients complain of:
Dilation and distance of the abdomen,
stru tu manipulations (women),
Decreased energy (men),
- Dry mucous membrane and skin,
- Violation of the gastrointestinal tract,
- Severe es arrhythmia or weight loss,
- Drowsiness or insomnia,
- Intense thirst, even at night
- Increase in bladder size,
- Excessive and frequent urination up to 4-30 liters per day.
There is also congenital diabetes insipidus, in which the symptoms are most pronounced in children, ranging from neurological disorders to vomiting and an increase in body temperature. During adolescence, such adolescents may lag behind in physical development.+
If the patient finds himself in a situation where you need to limit fluid intake, dehydration symptoms can occur because the kidneys are actively removing significant amounts of urine from the diseased body. In such cases, vomiting, mental disorders, headache, high body temperature, and even tachycardia may develop.
Before prescribing treatment, you should carefully clarify the diagnosis, determine its nature and form of diabetes, know the cause of the development of increased urination (polyuria) and thirst (polydipsia). For this purpose, the patient undergoes a comprehensive examination, which includes:
Determining diuretics and concentrations for sugar.
To determine specific gravity (low in diabetes insipidus) and daily urine volume, the Jimnitsky test is performed.
You can also determine the concentration in the blood plasma of antidiuretic hormone (less than 0.6 mg per liter).
For differentiation, a test is performed with dry eating, the main evaluation criteria of this sample are pulse rate, blood pressure level, general well-being, patient body weight, the relative density of urine, its discharge volume, the amount of urine excreted during this sample decreases and its volume increases. Although specific gravity, overall well-being, body weight, pulse, and blood pressure are normal and there are no other unpleasant symptoms, the diagnosis of diabetes insipidus is excluded.
MRI of the brain
If the tumor is the cause of the development of diabetes insipidus, the patient is transferred to surgery or radiotherapy. If the option with the tumor is excluded, treatment should be carried out in two directions: maximum restoration of water metabolism in the body and elimination of the pathological process in the hypothalamic-pituitary area.
Patients with severe polyuria, in which the daily urine exceeds 4 liters, should be prescribed specific antidiuretic therapy. In adults, severe polyuria can lead to enlargement of the bladder and atony, and in children, it can provoke growth retardation.
Today, the use of desmopressin is the main method of decomposition in the presence of central diabetes insipidus. This product is available in 2 forms: tablet ("Minirin") and Drops for Intranasal Administration ("Adiuretin").
Treatment of nephrogenic diabetes insipidus involves combined diuretics (triamper compositum, amyloretic, isobar), thiazide (hydrochlorothiazide), and potassium-sparing diuretics (spironolactone). During treatment, daily salt intake should not exceed 2 grams per day. In the presence of central diabetes insipidus, thiazide diuretics may also be used.
If the patient suffers from dipsogenic diabetes insipidus, it is contraindicated to treat it with a thiazide diuretic or desmopressin, as these drugs can provoke a severe form of water intoxication. Due to their use, water excretion is reduced and its consumption is not reduced. This type of diabetes insipidus should be treated by reducing water consumption and following a specific diet, including limiting salt and protein foods and increasing the consumption of vegetables, fruits, and dairy products.
Self-ation surgery with such severe pathology is a very dangerous task. Only a qualified physician can accurately diagnose the pathology and select the appropriate treatment for the patient.+
Diabetes insipidus - a disease caused by a complete or relative deficiency of the hypothalamic hormone vasopressin (ADH-antidiuretic hormone).
The frequency of the disease is unknown, occurring in 0.5-0.7% of endocrine patients.+
Regulation of vasopressin release and its effects
Vasopressin and oxytocin are synthesized in the supraptic and paraventricular nuclei of the hypothalamus, packed in granules with the corresponding neuroficin, and transported along the axons into the posterior pituitary gland (neurohypophysis) until they are released. Vasopressin reserves in the neurohypophysis are greatly reduced with prolonged stimulation of its secretion, for example, with long-term abstinence from alcohol.
Vasopressin secretion occurs for a number of reasons. The most important of these is osmotic blood pressure, ie. Osmolality (or osmolarity) of plasma. In the anterior hypothalamus, near, but apart from the superOptical and paraventricular nuclei, it has osmoreceptors . When the plasma osmolality is at a certain normal minimum or entry value, the vasopressin concentration in it is very low. If the plasma osmolality exceeds this set limit, the osmocentre absorbs it and the ratio of vasopressin increases significantly. The osmoregulation system responds very sensitively and very precisely. A slight increase in osmoreceptor sensitivity is associated with age.
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