Diabetes Insipidus – exhibiting increased thirst (patients drink from 5 to 25 liters water), polyuria, low relative hydrochloric urine density (1000-1004). Often combined with other endocrine and metabolic disorders and autonomic disorders mi.
Forms of diabetes insipidus.
- Central diabetes insipidus
- Renal diabetes insipidus (rare)
- Hepatic diabetes insipidus (very rare)
Causes.
The cause of central diabetes insipidus is the insufficiency of the supraoptic and paraventricular nuclei of the hypothalamus, whose neurons secrete antidiuretic hormone (ADH). Renal or nephrogenic diabetes is rare (renal tubule insensitivity to ADH). In renal diabetes, the body produces non-concentrated urine in large quantities. Another rare form of the disease is hepatic diabetes (increased destruction of ADH in the liver).
The cause is infectious, traumatic, swollen left and intoxication lesions of the hypothalamus. Described cases of diabetes insipidus after trauma and IP disappearance it on background therapy.
Clinic.
Reduction of ADH vyzy Vaeth polyuria, followed by and there is polydipsia. Syndrome is pathognomonic sign of the defeat of the hypothalamus and odes it a manifestation of neuroendocrine is the exchange disorders. The disease is mainly manifested by insatiable thirst and excessive urine production.
DIABETES SUGAR.
It is necessary to conduct laboratory and instrumental studies:
- Urinalysis with determination of density, sugar content, Zimnitsky test ;
- Determination of the level of antidiuretic hormone in blood plasma;
- For differential diagnosis, a dry-eating test is performed , that is, liquid is excluded from the patient’s diet. If during this test the amount of urine excreted decreases, its specific gravity increases, the blood pressure, pulse and body weight of the patient remain stable, their health improves and stable, then the diagnosis of diabetes insipidus is not confirmed.
- Carry out X-ray of the skull, MRI for suspected brain tumor.
TREATMENT.
- Surgical – with tumors.
- In central diabetes insipidus, hormone replacement therapy is prescribed : Adiurekrin , synthetic analogues of Vasopressin – Desmopressin ( adiuretin and minirin ). It is advisable to com bine them with diuretics: hydrochlorothiazide (25 mg per day in small courses – 5-6 days with a break of 2 weeks ).
- For the treatment of nephrogenic diabetes insipidus, it is most effective to combine potassium-sparing diuretics – Spironolactone , thiazide – Hydrochlorothiazide , combined diuretics – Isobar, Triampur , etc. In treatment, salt intake should be limited to 2 g / day . When taking diuretics, laboratory monitoring of the level of magnesium and sodium in the blood is necessary. In diabetes in the stage of decompensation, diuretics are contraindicated.
- Is shown receiving trankvi catalysts. Recently, the effectiveness of finlepsin has been discovered .