Endocrinology / / May 20, 2016
diabetes insipidus - a disease associated with a decrease in blood neurohypophyseal hormone - vasopressin.Lack vasopressin reduces reabsorption of water in kidney tubule release large amounts of urine with a low specific weight.Due to the large loss of fluid excretion occurs thirst.
Diabetes insipidus is a frequent symptom of various pathological processes in dientsefalo-pituitary region.As an independent painful form of diabetes insipidus is seen when it is not accompanied by other visible impairment of the pituitary gland or hypothalamus.
etiology of diabetes insipidus
Damage to the hypothalamus or neurohypophysis may be caused by various pathological processes.Of the 98 patients, 66 disease could be related to infection (syphilis, typhoid, influenza, scarlet fever, whooping cough, pneumonia, sepsis, malaria), 9 - with an injury, and 4 - with the tumor;19 patients there was no communication, diabetes insipidus with any preceding illness.Cases of diabetes insipidus in patients with acute leukem
Of the 124 patients, 40 people insipidus: diabetes arose in connection with a primary or metastatic tumor dientsefalo-pituitary region, 14 - the disease could be due to a variety of infectious processes, and 4 - with injuries, and 5 - with noninfectious granulomas (. xanthomatosis, etc.), in 2 - with vascular lesions.In 58 patients of this group of diabetes insipidus it can not be made dependent on any disease and was regarded as "idiopathic";three of them had a hereditary form of the disease.
In some forms of "idiopathic" diabetes insipidus undoubted role genetic factors, and the inheritance of the disease occurs on the dominant type.
Pathogenesis and causes of diabetes insipidus
resistant diabetes insipidus occurs naturally when damaged or supraoptic nuclei of the hypothalamus-pituitary tract above the median eminence.In the latter case there is retrograde degeneration supraoptic nuclei of cells.Isolated destruction or removal of the posterior lobe of the pituitary with intact median eminence does not lead to permanent diabetes insipidus, but can be accompanied by transient polyuria.
question of the etiology and pathogenesis of "idiopathic" diabetes insipidus remains largely unclear.Blotner found in three patients with diabetes insipidus without apparent reason has developed into a mature and old age, degenerative changes in supraoptiko-pituitary system, and suggests that "idiopathic" insipidus, diabetes is a systemic disease characterized by selective degeneration of the central nervous system.He uses the analogy with other local degenerative lesions "nervous system such as amyotrophic lateral sclerosis.In the opinion of Blotner, in cases of hereditary diabetes insipidus degenerative changes supraoptiko-pituitary system caused genetically, even if the disease has developed into adulthood.
described as the type of diabetes insipidus associated with an increased inactivation of vasopressin in the liver and kidney due to enzyme disorders.
excretion of large amounts of water and a decrease in plasma osmotic pressure causes irritation "thirst center", located in the hypothalamus, which leads to a sharp increase in water consumption.When intact "thirst center" loss of water in urine in patients with diabetes insipidus is fully compensated by fluid intake, and if drinking is not limited to, dehydration does not occur.
Pathological anatomy diabetes insipidus
Some patients found the tumor, inflammatory changes or non-infectious granulomas, which caused damage to the neurohypophysis.However, in many cases, these pathological processes are absent, and only under microscopic examination can sometimes reveal degenerative changes in the supraoptic nuclei and supraoptiko-pituitary tract.
clinical picture. diabetes insipidus can occur at any age in both sexes.Of the 128 patients, nalbyudaemyh AA Atabay, 80 people became ill at the age of 25 years, including 19 people - up to 5 years.The disease can occur suddenly, but in some patients the symptoms develop gradually.
main and sometimes the only manifestation of the disease are increased thirst and urine output.The primary here is the increased allocation of water in urine;therefore limiting drinking sick diabetes insipidus is pointless and dangerous.
number of fluid intake and urine output in most patients is 3-8 liters per day.However, in some patients, diuresis and hence the amount of fluid intake are significantly large, reaching 30-40 liters per day.The thirst and increased urine output does not stop, day or night.Patients prefer to drink cold water.The feeling of thirst can be so strong and painful that patients while limiting the water they drink any liquid right up to his own urine.
When intact centers that regulate thirst, dehydration symptoms in patients was observed.In the case of unconscious patients due to trauma or anesthesia, when they are not able to make up for the loss of fluid, rapidly evolving phenomenon of dehydration (dry skin and mucous membranes, reducing the turgor of tissues, fever, mental disorders, collapse).In very rare cases, the disease process is not limited to centers that regulate diuresis, but also on the "thirst center."In these patients there is a high fever and mental disorders, even with the introduction of a sufficient quantity of liquid and properly conducted substitution treatment.When deprivation of fluid may occur necrosis of renal tubules.
appetite in patients with diabetes insipidus is often lowered, which leads to weight loss.Often patients complain of weakness, constipation, chilliness.
Noteworthy is the absence of sweating, even in cases where the loss of water in urine is fully compensated by plentiful drinking.
AA Atabey often observed in patients in whom the disease started in childhood, retarded physical development, short stature.He attributes this to malnutrition due to poor appetite.
Puberty at the beginning of the disease in children is often delayed.In men, there may be a decrease and potency.AA Atabey often observed in women menstrual disorders, deviations from the norm in the cardiovascular system, the lungs, the liver usually does not happen.
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those patients whose diabetes insipidus is the result of damage dientsefalo-pituitary regionswelling, inflammation, and so on. n., symptoms may occur related to increased intracranial pressure, compression of the optic chiasma, endocrine-metabolic and autonomic disorders.In such cases, diabetes insipidus should be considered as a symptom;the diagnosis in these patients should reflect the underlying disease.
When combined with diabetes insipidus anterior pituitary insufficiency diuresis may be relatively small due to the decrease in glomerular filtration.In the appointment of glucocorticoid substitution treatment symptoms of diabetes insipidus are amplified.
From laboratory studies the most important urine.Urine Specific Gravity is low - in the range of 1,000-1,005, and even by limiting fluid intake, and severe dehydration does not exceed 1,010.Protein in the urine is not, and the study of urinary sediment reveals no abnormalities.
There are indications that in patients with diabetes insipidus is often the basal metabolic rate is increased.However, of the 30 patients examined AA Atabay, only 8 basal metabolic rate has been raised, and 5 was reduced, from 17 - normal.