General characteristics of the disease
Diabetes insipidus - a syndrome caused by a deficiency in the body of vasopressin. This substance is also called antidiuretic hormone. It is produced in the hypothalamus, stored in the pituitary gland is responsible for balance and body fluids: blood, water, the extracellular portion of the liquid, etc.
Diabetes insipidus is caused by abnormalities of the pituitary gland, provoked by benign or malignant metastatic tumors. Another possible cause of destructive processes in the pituitary gland - failed surgery on the brain. About every 5 case of diabetes insipidus - an example of a failed neurosurgical operations.
Diabetes insipidus is not a hereditary disease. However, a number of autosomal recessive inherited syndromes, such as Wolfram's disease full- or part diabetes insipidus is part of the clinical picture of a genetic mutation.
Diabetes insipidus - a rare disease. It leaves not more than 0, 7% of all endocrine pathologies. Diabetes insipidus is diagnosed with equal frequency in men and women. In children, diabetes insipidus is usually congenital form, although its diagnosis can happen quite late - after 20 years. In adults, the most diagnosed form of the disease acquired.
Types of diabetes insipidus
In addition to congenital diabetes insipidus in children and acquired forms of the disease in adults can also be central, renal, or idiopathic.
Central diabetes insipidus
Central or hypothalamic-pituitary diabetes insipidus is caused by the inability of the kidneys to accumulate fluid. This pathology is caused by abnormalities in the distal tubules of the nephron. As a consequence, central diabetes insipidus patient suffers from frequent urination and polydipsia - syndrome unquenchable thirst.
If the patient has to drink unlimited amounts of liquid, it is practically no danger. If it is impossible just to quench the thirst of the patient with diabetes insipidus develops this form of severe dehydration (hyperosmolar dehydration). Last stage of this syndrome - a life-threatening patient hyperosmolar coma.
When this long central diabetes insipidus patient appears renal insensitivity to artificially introduced antidiuretic hormone. Therefore, the sooner treatment is started this form of diabetes insipidus, more favorable prognosis.
In addition, large quantities of fluid consumed for diabetes insipidus can cause biliary dyskinesia, or development bathygastry irritable bowel syndrome.
Idiopathic diabetes insipidus
One third of cases of diabetes insipidus, idiopathic forms. This means that at the time of diagnosis of diabetes insipidus of the pituitary gland when rendering any organic pathology is not possible to identify.
Renal diabetes insipidus
The disease is caused by the receptor, enzymatic defect or organic renal disease. This is a fairly rare form of diabetes insipidus in children is usually congenital. Her provoke gene mutations, or aquaporin-2 vasopressin receptor.
Acquired renal diabetes insipidus in adults is caused by renal failure of different etiology, long-term therapy with lithium, hypercalcemia, etc.
The symptoms of diabetes insipidus
The main symptoms of diabetes insipidus are frequent urination (polyuria), thirst syndrome (polydipsia). Severity of these symptoms of diabetes insipidus may be of varying intensity.
With a partial deficiency of antidiuretic hormone can be only a small manifestation of the symptoms of diabetes insipidus. For the idiopathic form, in contrast, is characterized by the acute onset of the disease.
Clinical symptoms of diabetes insipidus long the current form are:
- increasing the size of the bladder,
- stretching and ptosis of the stomach,
- hypotension (low blood pressure)
- signs of dehydration.
The symptoms of diabetes insipidus in children may be particularly acute, until the development of neurological disorders, sudden fever, vomiting debilitating, urinary incontinence and hyperosmolar coma.
Diagnosis of diabetes insipidus
In the diagnosis of diabetes insipidus polyuria test applies. The normal urine output should not exceed 3 liters per day. For the patient's urine diabetes insipidus characterized by the excess of these indicators, as well as low density of urine.
The second test used in the diagnosis of diabetes insipidus, called test with suhoedeniem. The patient is recommended to refrain from drinking for 8 hours. If during this period of time the patient has a dramatic decrease in body weight and the density of urine does not exceed 300 mOsm / L, the patient is diagnosed "diabetes insipidus".
The differential diagnosis of diabetes insipidus diabetes involves insulin-dependent form of exclusion, organic kidney disease, psychiatric and neurological disorders, the presence of tumors in the hypothalamic-pituitary region.
Treatment of diabetes insipidus
The basis of the treatment of diabetes insipidus replacement therapy with synthetic vasopressin analogue. For drugs that can compensate for the level of antidiuretic hormone in the body, include desmopressin or Adiuretin. They are issued in the form of pills or nasal sprays.
In the treatment of diabetes insipidus tableted dosage of desmopressin apply to 0, 4 mg 3-4 times a day. Injecting fluid into the nose with the synthetic vasopressin also be carried out at least three times a day.
In the treatment of diabetes insipidus are also used drugs with a longer effect of the action, for example, Pitressin Tanat. It can be used 3-5 times per 1 day.
An important role in the treatment of diabetes insipidus plays dietetics. All patients with deficiency of antidiuretic hormone in the body is recommended fractional eat and increase the amount of complex carbohydrates (potatoes, vegetables, cereals, pulses, meat, nuts).
Encouraging development of the natural vasopressin with incomplete form of diabetes insipidus and conducted preparations Hlorpropamid Karbomazepin.
Patients with pituitary tumor, surgical treatment of diabetes insipidus - removal of the tumor and, if necessary, the radiation exposure.