Diabetes insipidus: Causes, Symptoms, Treatment
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Diabetes insipidus is a pathology of metabolism resulting from deficiency of antidiuretic hormone (ADH), or in violation of kidney tissue sensitivity to its action. The result is frustration and loss of exchanging large quantities of liquid urine. Thus ADH deficiency can be absolute, as a result of infringement of its secretion, or relative, in violation of his actions with enough of the hormone in the blood. As a result of disturbances in the metabolism of liquid forms strong thirst and severe dehydration. Usually develops in people over the age of 20 years, rarely in children. Sometimes it is formed as a complication after brain surgery.
Diabetes insipidus: Causes
The main causes of diabetes are dependent on what the departments in the chain of regulation damaged. Most often, there are central forms of diabetes. The main reasons for their occurrence:
- destruction of the hypothalamus-pituitary gland as a result of the tumor,
- metastasis to the pituitary gland,
- neurosurgical operations on the brain and the pituitary gland,
- Malaria defeat, syphilis or tuberculosis.
A special form of idiopathic diabetes insipidus is caused by the formation of specific antibodies to the field of hormone-producing cells, causing tissue damage.
Nephrogenic diabetes insipidus form usually occurs as a variant of congenital or acquired kidney lesions — these are the reasons for a hypercalcemia, amyloidosis, renal failure, lithium poisoning. Diabetes insipidus can also be one of the symptoms of hereditary congenital symptoms such as Wolfram Syndrome.
Diabetes insipidus: Classification
In modern conditions of diabetes insipidus classify, given the level of destruction, where there were violations and the first signs of diabetes. Provided:
- central, hypothalamic-pituitary or neurogenic diabetes, occurs as a result of violation of the synthesis of pituitary hormones, or in connection with the problems of its release into the bloodstream. Central diabetes is subdivided into idiopathic (innate) form, which inherently occurs in children due to mutations, and symptomatic form occurs as a symptom of various types of pathologies. Symptomatic diabetes insipidus occurs as acquired during the life of the disease, its symptoms can be caused by brain injury, neuroinfections, tumors, ischemia of brain tissue, etc.
- renal or nephrogenic diabetes results from kidney tissue insensitivity to the action of ADH. It may be due to a congenital defect of neurons, sensory disturbances receptor system, kidney damage or toxic drugs.
Diabetes insipidus: Symptoms
The disease can appear dramatically or grow slowly, often provoke her pregnancy, head injury or infection.
The most typical symptoms of diabetes insipidus — a polydipsia (or uncontrollable thirst) and polyuria (excessive urine separation). Through Urine very low density there is a plentiful selection of body fluids, up to five or more liters. This will launch a strong thirst mechanisms. The lower the level of the hormone — the more symptoms.
When expressed almost colorless urine diabetes, its density not exceeding 1001-1003, therein small solutes and salts. The patient is forced almost constantly to drink and go to the toilet, which disrupts ordinary life. Frequent trips to the bathroom leads to sleep disorders and neurosis, fatigue, emotional changes. In children, manifestation of diabetes insipidus can be bedwetting, delayed physical development, disorders of puberty. In later stages of renal lesions arise system extension pelvis and ureter, bladder lesions due to overload water stretched stomach, intestinal problems develop and biliary system.
The skin in patients with dry, reduced perspiration, saliva and disturbed appetite. Gradually joined symptoms of dehydration, severe emaciation, vomiting and headaches, pressure reduction. Can join neurological disorders and symptoms of pituitary insufficiency. Women suffer menstrual cycles and reproductive function in men — in libido and erections. Sudden changes show blood and urine tests.
Diabetes insipidus: Diagnostics
In typical cases, polydipsia and polyuria with suspected disease difficult, especially when the allocation per day and more than three liters of urine. conducted laboratory tests for accurate diagnosis:
- general analysis of blood and urine tests with detection of low density,
- Analysis of urine on the ionic composition,
- fasting glucose,
- ADH levels in blood plasma
- Sample Zimnitsky, Addison,
- test with dry diet.
diabetes insipidus diagnosis is confirmed by carrying out X-ray, ophthalmic and neuropsychiatric examinations, reveal the reasons for its development. If necessary, appointed by CT and MRI, renal ultrasound, ECG, renal biopsy tissue.
Diabetes insipidus: Treatment
In order to decide on how to treat diabetes insipidus, you must know exactly what causes it. diabetes insipidus symptomatic nature of treatment is carried out by eliminating the causes (tumor removal). In all forms of diabetes is assigned to substitution treatment with synthetic analogues of ADH. The drug is administered orally or nose drops instilled depending on the selected drug. When the central forms used drugs, stimulants of ADH. You should always correction of water-salt metabolism intravenous administration of solutions in large volume, is significantly reduced urine output with diabetes insipidus taking hydrochlorothiazide.
A special role is played by diet in the treatment of protein restriction and reduced load on the kidneys with enough fat and carbohydrates, frequent meals, increasing the amount of fruits and vegetables, frequent thirst quencher.
Diabetes insipidus: Forecasts
Diabetes insipidus is dangerous in itself. Its effects are severe enough, especially in any form. Severe dehydration can lead to coma, a disorder of all kinds of exchanges, neurological problems. If diabetes insipidus is made disability because the patient has to take a lot of medicines and is constantly on duty at the toilet. At the slightest deviation in diet and taking medications may occur serious complications, including death. A favorable outcome may be not started with symptomatic forms of diabetes.