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  • Non-diabetes mellitus - Causes, symptoms and treatment. MF.

    The term "diabetes insipidus" combines diseases characterized by the release of a large amount of diluted urine. Most often, these diseases are associated with impaired production or action of antidiuretic hormone( ADH).

    The body has a complex system for balancing the volume and composition of the fluid. Kidneys, removing excess fluid from the body, form urine, which accumulates in the bladder. When water intake decreases or there is a loss of water( excessive sweating, diarrhea), the kidneys will produce less urine to keep the fluid in the body. Hypothalamus - the brain region responsible for the regulation of the entire endocrine system of the body, produces an antidiuretic hormone( ADH), also called vasopressin. ADH is stored in the pituitary gland located next to the hypothalamus at the base of the brain. When ADH reaches the kidneys, it causes a reverse absorption of water into the bloodstream, that is, a decrease in the amount of urine. Similarly, ADH acts on blood vessels, causing their constriction, but this effect is manifested only in critical situations, for example, with blood loss or shock.

    There are four types of diabetes insipidus:

    1) central diabetes insipidus
    2) nephrogenic diabetes insipidus
    3) dipsoogenic diabetes insipidus
    4) gestational diabetes is insipid.

    Non-diabetes is a rare disease, unlike diabetes mellitus. Diabetes mellitus is the result of insulin deficiency or insulin resistance and causes an increase in blood glucose( sugar).Recall that diabetes is threatening with its complications, is the cause of disability and high mortality. And diabetes insipidus is a disease with a more favorable prognosis. These two diseases are not related, although they may have similar signs and symptoms, such as increased thirst and excessive urination.

    Symptoms of diabetes insipidus

    The main symptom of diabetes insipidus is the allocation of a large amount of urine. The mild forms of diabetes insipidus cause a loss of fluid from 2 to 2.5 liters per day, in severe cases, the volume of urine reaches 20 liters per day. As a result of fluid loss, a person with diabetes insipidus feels thirsty, a need to drink a large number of drinks, more often patients prefer cold drinks, since they quench their thirst better. Frequent urination, including at night, can lead to sleep disturbances and, in some cases, cause bed wetting. In connection with the allocation of abnormally large volumes of diluted urine, people with diabetes insipidus can be dehydrated if they do not drink enough water. Dehydration is extremely dangerous, since the central nervous system suffers primarily from lack of fluid. The defeat of the central nervous system can cause symptoms such as irritability, or, conversely, lethargy, fever, vomiting or diarrhea, inhibition and even to whom. Therefore, should never be restricted in patients with diabetes insipidus in consuming liquids!

    Diagnosis of diabetes insipidus

    In most cases, the diagnosis of diabetes insipidus does not represent difficulties.
    In the first stage, the fact of the presence of diabetes insipidus is established with the help of clinical signs( complaints of thirst, frequent, profuse urination) and urine tests, indicating a decrease in its concentration.

    In the general analysis of the morning portion of urine, an increase in the amount of urine can be detected, a decrease in specific gravity. Zininitsky's trial is very common. For its carrying out, it is required to collect urine during the day in 8 containers, one container is designed for 3 hours. Next, in each portion, the amount and specific gravity are determined. The urine of a person with diabetes insipidus is less concentrated in all portions.

    In doubtful cases, a liquid deprivation test is performed. This test is rather complicated, it should only be done in a hospital setting, it is rarely used.

    It is also necessary to exclude diabetes by measuring blood glucose.
    The features of the diagnosis of each type of diabetes insipidus are described below.

    Treatment of diabetes insipidus

    Central diabetes insipidus

    The most common and serious form of diabetes insipidus is non-diabetes mellitus of central origin as a result of damage to the pituitary gland. Damage to the pituitary gland can be caused by various causes: tumors of the pituitary and hypothalamus, infectious diseases, craniocerebral trauma, neurosurgical intervention, or genetic disorders.
    Magnetic resonance imaging( MRI) of the brain is needed to determine the cause of central diabetes insipidus. Sometimes the cause of central diabetes insipidus can not be identified, and then it is called idiopathic.

    For the treatment of ADH deficiency arising from damage to the hypothalamus or pituitary gland, a synthetic analogue of this hormone desmopressin( Presayneks, Vasomyrin, Minirin, Nativa) is used as a nasal spray or tablets. Taking desmopressin, a person should drink fluids only with thirst, and not at other times. The drug promotes the inverse absorption of water in the kidneys, and water can accumulate in the body, causing water intoxication. The dosage of desmopressin is selected individually. Usually the average daily dose for adults is 10-40 μg, for children 10-20 μg. The daily dose can be taken once, it is also possible to divide it into two, rarely three, admission. As a rule, the drug is well tolerated.

    To side effects of the drug desmopressin include headache, dizziness, impaired consciousness, intestinal colic, nausea, vomiting, moderate increase in blood pressure, menstrual irregularities, skin rashes. When taking the drug in the form of a spray or drops in the nose, swelling of the nasal mucosa is possible.

    In no case should you take the drug without a doctor's prescription, guided by the presence of symptoms such as thirst and frequent urination. Taking desmopressin with nephrogenic, dipsoogenic diabetes insipidus is contraindicated, can lead to serious complications.

    Patients taking desmopressin preparations intranasally, i.e.in the form of drops or spray in the nose, it should be remembered that with a cold there is swelling of the nasal mucosa, and possibly a decrease in absorption of the drug. In these cases, sublingual administration of the drug is recommended;under the tongue.

    Nephrogenic diabetes insipidus

    Nephrogenic diabetes insipidus arises from the inability of the kidneys to respond to ADH.The ability of the kidneys to respond to ADH can be adversely affected by drugs( lithium preparations), chronic diseases, including polycystic kidney disease, sickle cell anemia, kidney failure, urolithiasis, and hereditary genetic disorders. In cases where the cause of nephrogenic diabetes insipidus is not detected, a diagnosis of idiopathic nephrogenic diabetes insipidus is established.

    Sometimes, in order to distinguish central diabetes insipidus from nephrogenic, trial treatment with desmopressin drugs is required. It will be ineffective in the nephrogenic type. To determine the cause of this type of diabetes insipidus, a thorough examination of the kidney function is necessary.

    Diuretics( hydrochlorothiazide, amiloride) and, as an additional treatment, non-steroidal anti-inflammatory drugs( indomethacin) are used to treat nephrogenic diabetes insipidus. It is also effective to moderate the restriction of table salt.

    Dipsoogenic diabetes insipidus

    Dipsoogenic diabetes insipidus is caused by a defect or damage to the center of thirst that is in the hypothalamus. This defect leads to abnormal thirst and consumption of a large amount of fluid. Due to the consumption of a large amount of liquid, the secretion of ADH is suppressed and the volume of excreted urine increases. Often this type of diabetes insipidus is combined with mental disorders. Desmopressin or other drugs should not be used to treat dipsoogenic diabetes insipidus, since they can reduce the amount of urine, but can not affect thirst and fluid intake. There may be a fluid overload - water intoxication and serious damage to the brain. Scientists have not yet found effective treatment of dipsoogenic diabetes insipidus.

    Gestational diabetes insipidus

    Gestational diabetes insipidus arises only during pregnancy as a result of the placenta enzymes destroying the mother's ADH.Frequent urination occurs, usually in the third trimester, after delivery without any treatment. The level of ADH is usually reduced.
    Most cases of gestational diabetes insipidus can be treated with desmopressin.

    Doctor endocrinologist Fayzulina N.М.