Diabetes insipidus. Diabetes insipidus: symptoms in women, treatment

Diabetes insipidus is a disease caused by either a decrease in the production of vasopressin (antidiuretic hormone) or a decrease in the sensitivity of receptors to the perception of this hormone. The disease most often occurs among people aged twenty to thirty years, but is often recorded in childhood. Diabetes insipidus is a rather rare pathology, but there is a tendency towards an increase in incidence, mainly due to central shape diseases.

Vasopressin is synthesized in the hypothalamus and then enters the pituitary gland. The hormone enters the blood directly from the pituitary gland. The main function of vasopressin is the regulation of water balance.

IN renal tubules reabsorption occurs - the reabsorption of essential microelements and water into the blood. As vasopressin levels decrease, water reabsorption decreases. Thus, water is not absorbed back, but is excreted in the urine. large quantities. Thus, with diabetes insipidus, the volume of daily diuresis can reach twenty liters!

There are several types diabetes insipidus:

• Central- caused by a violation of the synthesis of vasopressin by the hypothalamus or a violation of its secretion by the pituitary gland.
• Nephrogenic- caused by resistance to vasopressin receptors located in the kidneys.
• Primary polydipsia- occurs with pathological thirst (dipsogenic polydipsia) or obsessive desire to drink (psychogenic polydipsia). In these cases, with excessive water consumption, the production of vasopressin is compensatory reduced.
• Progestational- is associated with excessive activity of a specific enzyme produced by the placenta - arginine aminopeptidase, which destroys vasopressin.
• Functional- observed in children under one year of age due to age-related imperfections in the concentration function of the kidneys. Excessive activity of the enzyme phosphodiesterase type 5 leads to a deterioration in the responsiveness of vasopressin to renal receptors.
• Iatrogenic- caused by taking diuretics.

Diabetes insipidus can be congenital or acquired. The congenital type of diabetes insipidus is associated with genetic disorders. And acquired can occur under the influence of many factors.

Reasons leading to the development of central diabetes insipidus:

1. Brain injuries;
2. Operations performed on the brain;
3. Brain tumors and metastases;
4. Hypoxic, ischemic brain damage;
5. Vascular pathology - vascular malformation, aneurysm;
6. Brain granuloma;
7. Infectious diseases.

Reasons leading to the development of nephrogenic diabetes insipidus:

1. Metabolic disorders - hypercalcemia, hypokalemia;
2. Chronic renal failure in the polyuric stage;
3. Taking nephrotoxic drugs;
4. Polycystic kidney disease;
5. Kidney amyloidosis;
6. Pyelonephritis;
7. Sjögren's syndrome.

Symptoms of diabetes insipidus

The most early sign The disease is polyuria - increased diuresis. On average, patients experience an increase in diuresis to five to six liters of urine per day. The urge to urinate occurs even at night. When water intake is limited, the patient's condition worsens: headache, increased heart rate, decreased blood pressure, fever, vomiting, psychomotor agitation.

Against the background of excessive fluid loss, compensatory polydipsia occurs - thirst. Moreover, it is characteristic that thirst can be quenched only with the help cool water. In addition, dry skin and mucous membranes are observed, as well as a decrease in salivation and sweating.

In infants clinical symptoms differs from that in adults. This is due to the fact that if there is thirst, the child cannot report this, which means that the lost fluid is not fully restored. Children experience the following symptoms:

Note: in children early age against the background of dehydration, hypernatremia and hyperosmolarity of the blood quickly develop, accompanied by the appearance of seizures and the development of coma.

To identify diabetes insipidus, the following set of studies is carried out:

1. - low relative density is determined (1.000-1.005);
2. - high hematocrit, increased red blood cells;
3. Blood test for sugar - glucose is within normal limits;
4. - increased sodium;
5. Urine examination according to Zemnitsky - copious urine discharge, low relative density (1.000-1.005);
6. Test with dry food;
7. Test with desmopressin;
8. MRI of the brain;
9. Ultrasound of the kidneys.

Test with dry food

In the morning on an empty stomach, the patient is weighed and measured. arterial pressure and pulse. The level of sodium in the blood is determined, as well as osmolarity. And in urine, osmolarity and density are measured. Then the patient completely stops taking liquids for 6-14 hours, and food for eight. Every one to two hours the patient is weighed and all tests are repeated.

The study is stopped in the following situations:

• If you lose more than three to five percent of body weight;
• With severe general health;
• Unbearable thirst;
• Increased sodium levels and blood osmolarity above normal;
• Increased urine osmolarity over 300 mOsm/l.

The central genesis of diabetes insipidus is supported by an increase in blood osmolarity and sodium, as well as a loss of body weight by three to five percent.

And with nephrogenic genesis of diabetes insipidus, a decrease in the volume of diuresis, no changes in body weight are observed, sodium in the blood is within normal limits.

Desmopressin test

The desmopressin test is performed to determine the cause of diabetes insipidus. To do this, a person takes 0.1 mg of desmopressin. After two and then four hours, urine is collected to determine its volume and osmolarity.

If the osmolarity level increases by more than 50%, then the patient has central diabetes insipidus. If urine osmolarity increases by less than 50%, then the patient has a nephrogenic form of the disease.

Treatment of diabetes insipidus

Patients with diabetes insipidus should not limit their fluid intake. The only exceptions are those patients who have disorders of the thirst center. In this case, a fixed fluid intake is indicated.

The main drug used in the treatment of diabetes insipidus is an analogue of vasopressin - desmopressin, produced in the form of tablets and nasal drops. The goal of therapy is to select the minimum effective dose of medication to eliminate thirst and polyuria.

Note:Eating reduces the absorption of the drug and its effectiveness. Therefore, tableted desmopressin should be taken forty minutes before meals or two hours after.

Diabetes insipidus is quite rare endocrine disease, arising as a result of relative or absolute deficiency of vasopressin (non-hypophyseal hormone) and manifested by debilitating urination (polyuria) and severe thirst (polydipsia).

Let's look at more details about what kind of disease this is, what causes, symptoms in men and women, as well as what is prescribed as treatment for adults.

What is diabetes insipidus?

Diabetes insipidus is chronic illness hypothalamic-pituitary system, which develops due to a deficiency in the body of the hormone vasopressin, or antidiuretic hormone (ADH), the main manifestations of which are the release of large volumes of urine with low density.

Disease may start suddenly or develop gradually. Primary signs diabetes insipidus - increased thirst and frequent urination.

Despite the fact that there are two types of diseases similar in name - diabetes mellitus and diabetes insipidus, these are two completely different diseases, but the symptoms overlap. They are united only by some similar signs, but the diseases are caused entirely various disorders in organism.

The body has a complex system for balancing the volume and composition of fluid. Kidneys, removing excess liquid from the body, form urine, which accumulates in bladder. When water intake decreases or there is water loss (excessive sweating, diarrhea), the kidneys will produce less urine to conserve fluid in the body.

The hypothalamus, a part of the brain responsible for regulating the entire endocrine system of the body, produces antidiuretic hormone (ADH), also called vasopressin.

In diabetes insipidus, everything that is filtered excreted from the body. This results in liters and even tens of liters per day. Naturally, this process creates a strong thirst. A sick person is forced to drink a lot of fluid in order to somehow compensate for its deficiency in the body.

Diabetes insipidus is a rare endocrinopathy that develops regardless of gender and age group patients, most often in people 20-40 years old. In every 5th case, diabetes insipidus develops as a complication of neurosurgical intervention.

In children, diabetes insipidus usually has a congenital form, although its diagnosis can occur quite late - after 20 years. In adults, the acquired form of the disease is more often diagnosed.

Classification

Modern endocrinology classifies diabetes insipidus depending on the level at which disorders occur. There are central (neurogenic, hypothalamic-pituitary) and renal (nephrogenic) forms.

Neurogenic diabetes insipidus

Neurogenic diabetes insipidus (central). Develops as a result pathological changes V nervous system, in particular, in the region of the hypothalamus or posterior pituitary gland. As a rule, the cause of the disease in this case is surgery for complete or partial removal pituitary gland, infiltrative pathology of this area (hemochromatosis, sarcoidosis), trauma or changes of an inflammatory nature.

In turn, the central type of diabetes insipidus is divided into:

• idiopathic – hereditary type a disease characterized by a decrease in ADH synthesis;
• symptomatic – develops against the background of other pathologies. It can be either acquired (develops throughout life), for example, as a result of a head injury or the development of a tumor. Or congenital (due to gene mutation).

With long-term central diabetes insipidus, the patient develops renal insensitivity to artificially administered antidiuretic hormone. Therefore, the sooner treatment for diabetes insipidus of this form is started, the more favorable the prognosis.

Renal diabetes insipidus

What it is? Renal or nephrogenic DI is associated with decreased sensitivity of kidney tissue to the influence of vasopressin. This type of disease is much less common. The cause of the pathology is either the structural inferiority of the nephrons or the resistance of the renal receptors to vasopressin. Renal diabetes may be congenital or may occur as a result of damage kidney cells under the influence of medications.

Sometimes a third type of diabetes insipidus is also identified, affecting women during pregnancy. This is quite a rare occurrence. It occurs due to the destruction of hormones by enzymes of the resulting placenta. After the baby is born, this type goes away.

Acquired renal diabetes insipidus in adults develops as a result of renal failure of various etiologies, long-term therapy with lithium drugs, hypercalcemia, etc.

Causes

Diabetes insipidus develops when there is a deficiency of the antidiuretic hormone (ADH) vasopressin - relative or absolute. ADH is produced by the hypothalamus and it performs various functions, including influencing normal work urinary system.

Diabetes insipidus is not a hereditary disease, but some autosomal recessive inherited syndromes (for example, Wolfram's disease, complete or incomplete diabetes insipidus) are part of the clinical picture, indicating a genetic mutation.

Factors predisposing to the development of this pathology are:

• diseases infectious nature, especially viral ones;
• brain tumors (meningioma, craniopharyngioma);
• metastases to the hypothalamus of cancer of extracerebral localization (usually bronchogenic - originating from bronchial tissue, and breast cancer);
• skull injuries;
• concussions;
• genetic predisposition.

In the idiopathic form of diabetes insipidus in the patient’s body without apparent reason Antibodies begin to be produced that destroy the cells that produce antidiuretic hormone.

Renal diabetes insipidus (renal form) occurs as a result of body intoxication chemicals, disorders or previous diseases of the kidneys and urinary system (renal failure, hypercalcinosis, amyloidosis, glomerulonephritis).

Symptoms of diabetes insipidus in adults

The disease occurs equally in men and women, at any age, most often between the ages of 20-40 years. The severity of the symptoms of this disease depends on the degree of vasopressin deficiency. With a slight deficiency of the hormone, clinical symptoms may be blurred and not clearly expressed. Sometimes the first symptoms of diabetes insipidus appear in people who have been in conditions of drinking deficiency - during travel, hiking, expeditions, and also when taking corticosteroids.

The main symptoms of diabetes insipidus include the following:

• excessive urination (up to 3–15 liters of urine per day);
• the main volume of urination occurs at night;
• thirst and increased fluid intake;
• dryness skin, nausea and vomiting, convulsions;
• mental disorders (, emotional lability, decreased mental activity).

Even if the patient is limited in fluid intake, urine will still be released in large quantities, which will lead to general dehydration of the body.

Besides common features, there are a number of individual symptoms that occur in patients of different genders and ages:

Complications

The danger of diabetes insipidus lies in the risk of developing dehydration of the body, which occurs in situations in which the loss of fluid from the body through urine is not adequately replenished. For dehydration characteristic manifestations are:

• general weakness and
• vomit,
• mental disorders.

Blood thickening is also noted, neurological disorders and hypotension, which can reach a state of collapse. It is noteworthy that even severe dehydration is accompanied by persistence of polyuria.

Diagnostics

A doctor who deals with such pathologies is an endocrinologist. If you feel most of the symptoms of this disease, then the first thing you should do is go to an endocrinologist.

At your first visit, the doctor will conduct an “interview”. It will allow you to find out how much water a woman drinks per day, whether there are problems with menstrual cycle, urination, she has endocrine pathologies, tumors, etc.

In typical cases, the diagnosis of diabetes insipidus is not difficult and is based on:

• pronounced thirst
• daily urine volume is more than 3 liters per day
• plasma hyperosmolality (more than 290 mOsm/kg, depends on fluid intake)
• high sodium content
• hypoosmolality of urine (100–200 mOsm/kg)
• low relative density urine (<1010).

Laboratory diagnosis of diabetes insipidus includes the following:

• conducting a Zimnitsky test - accurate calculation of daily fluid consumed and excreted;
• ultrasound examination of the kidneys;
• X-ray examination of the skull;
• computed tomography of the brain;
• echoencephalography;
• excretory urography;
• detailed biochemical blood test: determination of the amount of sodium, potassium, creatinine, urea, glucose ions.

The diagnosis of diabetes insipidus is confirmed based on laboratory data:

• low urine osmolarity;
• high level of blood plasma osmolarity;
• low relative density of urine;
• high sodium levels in the blood.

Treatment

After confirming the diagnosis and determining the type of diabetes insipidus, therapy is prescribed aimed at eliminating the cause that caused it - tumors are removed, the underlying disease is treated, and the consequences of brain injuries are eliminated.

To compensate for the required amount of antidiuretic hormone for all types of disease, desmopressin (a synthetic analogue of the hormone) is prescribed. It is applied by instillation into the nasal cavity.

Desmopressin drugs are now widely used to compensate for central diabetes insipidus. It is produced in 2 forms: drops for intranasal administration - Adiuretin and tablet form Minirin.

Clinical recommendations also include the use of drugs such as Carbamazepine and Chlorpropamide to stimulate the body’s production of the hormone. Since excessive urine production leads to dehydration of the body, saline solutions are administered to the patient to restore the water-salt balance.

When treating diabetes insipidus, drugs that affect the nervous system (for example, Valerian, Bromine) can also be prescribed. Nephrogenic diabetes requires the prescription of anti-inflammatory drugs and thiazide diuretics.

An important component of treatment diabetes insipidus is the correction of water-salt balance using infusion of a large volume of saline solutions. To effectively reduce diuresis, it is recommended to take sulfonamide diuretics.

Thus, diabetes insipidus is the result of a deficiency of antidiuretic hormone in the human body for various reasons. However, modern medicine makes it possible to compensate for this deficiency with the help of replacement therapy with a synthetic analogue of the hormone.

Competent therapy returns a sick person to the mainstream of a full life. This cannot be called a complete recovery in the literal sense of the word, however, in this case, the state of health is as close as possible to normal.

Nutrition and diet for diabetes insipidus

The main goal of diet therapy is to reduce urination, and in addition, to replenish the body with vitamins and minerals that they “lose” due to frequent urge to go to the toilet.

It is worth giving preference to cooking in these particular ways:

• boil;
• steamed;
• stew food in a saucepan with olive oil and water;
• bake in the oven, preferably in a sleeve, to preserve all the beneficial substances;
• in a slow cooker, except for the “fry” mode.

When a person has diabetes insipidus, the diet should exclude those categories of foods that increase thirst, for example, sweets, fried foods, spices and seasonings, and alcohol.

The diet is based on the following principles:

• reduce the amount of protein consumed, leaving the norm of carbohydrates and fats;
• reduce salt concentration by reducing its consumption to 5 g per day;
• food should consist mainly of vegetables and fruits;
• to quench your thirst, use natural juices, fruit drinks and compotes;
• eat only lean meat;
• include fish and seafood, egg yolks in the diet;
• take fish oil and phosphorus;
• eat small meals often.

Sample menu for the day:

• first breakfast – omelet (steamed) of 1.5 eggs, vinaigrette (with vegetable oil), tea with lemon;
• second breakfast – baked apples, jelly;
• lunch - vegetable soup, boiled meat, stewed beets, lemon drink;
• afternoon snack – rosehip decoction, jam;
• dinner - boiled fish, boiled potatoes, sour cream, tea with lemon.

Drinking plenty of fluids is necessary - after all, the body loses a lot of water during dehydration and needs to be compensated.

Folk remedies

Before using folk remedies for diabetes insipidus, be sure to consult an endocrinologist, because possible contraindications.

1. Twenty grams of dried elderberry blossoms pour a glass of very hot water, and the resulting broth is infused for one hour. The resulting composition is mixed with a spoon of honey and consumed three times daily.
2. To significantly get rid of thirst and reduce urine output, it is necessary to be treated with burdock infusion. To prepare the product, you will need 60 grams of the root of this plant, which must be crushed as much as possible, poured into a liter thermos and filled with boiling water until the volume is full. You need to infuse burdock root until the morning, after which the remedy is taken 3 times a day, half a glass.
3. Motherwort infusion for diabetes insipidus. Ingredients: motherwort (1 part), valerian root (1 part), hop cones (1 part), rose hips and mint (1 part), boiling water (250 ml.). All herbal ingredients are mixed and thoroughly crushed. Take 1 spoon of the mixture and pour boiling water over it. They insist for an hour. Take in an amount of 70 - 80 ml. before bedtime. Benefits: the infusion calms the body, relieves irritability, and improves sleep.
4. To reduce thirst and restore balance in the body, you can use infused walnut leaves. The young leaves of this plant are collected, dried and crushed. After this, a teaspoon of the dry substance is brewed with a glass (250 milliliters) of boiling water. After just fifteen minutes, the resulting decoction can be consumed like regular tea.
5. A collection of different herbs will also help overcome the disease: fennel motherwort, valerian, fennel, caraway seeds. All ingredients must be taken in equal quantities and mixed well. After this, a tablespoon of the dry mixture is poured into a glass of boiling water and left until the liquid cools completely. You need to take half a glass before bed.

Forecast

Diabetes insipidus, which develops in the postoperative period or during pregnancy, is often transient (transitory) in nature, while idiopathic diabetes is, on the contrary, persistent. With appropriate treatment there is no danger to life, although recovery is rarely recorded.

Recovery of patients is observed in cases of successful removal of tumors, specific treatment of diabetes insipidus of tuberculosis, malaria, and syphilitic origin. When hormone replacement therapy is prescribed correctly, the ability to work is often preserved.

The term “diabetes insipidus” refers to an endocrine disease characterized by a person’s thirst and diuresis of more than 2 liters of urine per day, which is not accompanied by an increase in blood glucose concentration. The condition can develop both as a result of a violation of the central regulation of urine formation, and as a result of pathology of the renal structures receiving signals. Symptoms of the disease have some differences in women, children and men. Treatment of the pathology is mandatory, since increased volumes of daily urine greatly change the water-salt balance, which affects all organs.

Anatomy and physiology in brief

The kidneys are a very important paired organ. They remove toxins and products of protein, fat and carbohydrate metabolism from the body; they produce hormones and substances that stimulate the formation of blood cells in the bone marrow. But the most important function is to maintain water-salt and acid-base balances, when the basic parameters of which change, the condition of all internal organs suffers and lethal changes can occur.

The main structural unit of the kidney is the nephron. It consists of a glomerulus and tubules. All these structures are closely related to the circulatory system. To understand how diabetes insipidus starts, consider the stages of urine formation:

1. In the glomerulus of the kidney, blood is filtered: large proteins (they are needed to maintain oncotic pressure in the blood, holding the fluid in the vessel) and blood cells go back into the channel, the blood fluid with smaller substances dissolved in it passes into the glomeruli.
2. There are blood vessels near the kidney tubules. The tubules, “checking” the content of various substances in the fluid supplied to them and in the blood, “decide” what to give back (these substances are absorbed into the vessels) and what to remove. Some substances that are not beneficial for the body are eliminated despite their concentration. The tubules also return most of the liquid that reaches them into the blood: so, about 150 liters of it enters per day, but only about 1.5 liters are released.
3. When everything that is needed has returned to the vessels, the remaining liquid (not much of it) with substances enters the urinary system. This is called secretion.

The activity of the kidney is regulated not so much by the content of various substances in the blood, but by the level of hormones such as:

• Renin, which is produced by the kidney itself. It enhances the reabsorption of sodium and water from the tubules into the vessels, thereby increasing blood pressure;
• Vasopressin (ADH, antidiuretic hormone), synthesized in the hypothalamus - a small gland in the cranial cavity, which is the main “conductor” of all hormonal processes in the body. The level of ADH is normally regulated by the concentration of sodium in the blood: the more there is, the more of the hormone. Vasopressin levels also decrease as renin concentrations decrease. The essence of the action of this hormone is to reduce the amount of urine excreted per day.
• There are other hormones that regulate kidney function, but we will not consider them in the context of this topic.

Types of disease

Depending on the level of damage, diabetes insipidus is:

1. Central genesis. The disease usually develops due to decreased synthesis of vasopressin in the hypothalamus. Also, central diabetes insipidus can develop if ADH is produced in normal quantities, but the pituitary gland - the second main endocrine gland, located near the hypothalamus and receiving commands directly from it - does not release all the hormone into the blood.
2. Renal: Normal amounts of vasopressin are synthesized, but the kidneys do not respond to it properly.
3. Functional diabetes insipidus: develops in some children under one year of age as a result of insufficient kidney maturity and increased activity of the enzyme that destroys vasopressin.
4. In pregnant women - as a result of increased production by the placenta of one of the enzymes that destroys antidiuretic hormone.
5. Primary polydipsia: due to thirst, which develops as a result of mental illness or brain pathology in women or men (very rarely - children), the synthesis of the hormone vasopressin is suppressed. If such a person loses a lot of fluid and does not have time to replenish it, hormone synthesis will be restored.
6. Iatrogenic: this kind of diabetes insipidus develops due to improper use of diuretics (usually for self-medication).

Causes of the disease

The causes of diabetes insipidus differ depending on the type of disease:

1. The nephrogenic form of diabetes develops:

• in children – due to a congenital disorder of the structure of renal receptors for vasopressin;
• in adults - due to the following reasons:

- excretion of glucose-rich urine through the kidneys (with diabetes);

— metabolic disorders;

— chronic renal failure;

- a condition that occurs after prolonged blockage of the ureter with a stone;

- uncontrolled use of certain drugs.

2. Central diabetes insipidus can also be congenital or acquired:

• the congenital form of the disease manifests itself in children due to:

- a defect in the gene responsible for the production of vasopressin;

- a hereditary syndrome, which includes not only kidney damage, but also optic disc atrophy and the development of type II diabetes mellitus;

— disorders of brain development in the prenatal period;

• The causes of acquired diabetes insipidus are as follows:

— consequences of influenza or other acute respiratory viral infections;

- brain surgery;

- tumors of the pituitary gland or hypothalamus;

- encephalitis;

- traumatic brain injury;

- neurosyphilis;

- metastases to the pituitary gland;

- sarcoidosis;

- ischemic brain damage;

- tuberculosis;

- histiocytosis;

- brain damage by cytomegalovirus or toxoplasma (these are usually diseases that appear in the prenatal period and appear in children);

- disturbances in the structure of blood vessels supplying the hypothalamic-pituitary zone.

Thus, diabetes insipidus in children most often occurs due to:

• immaturity of brain structures;
• damage to the hypothalamus or pituitary gland by intrauterine cytomegalovirus or toxoplasma infection;
• prolonged hypoxia in the prenatal period or during childbirth;
• congenital disorders of enzymes involved in the metabolism of vasopressin;
• birth or postpartum fractures of the base of the skull.

Symptoms

The signs of diabetes insipidus are the same in its central, nephrogenic or iatrogenic forms. The severity of its manifestations depends only on the concentration of ADH and the degree of immunity of the kidney receptors to this hormone.

Typically, the first symptoms of diabetes insipidus are as follows: some time after an injury or brain disease, or against their background, severe thirst develops, a large amount of light-colored urine appears (up to 20 l/day).

Subsequent symptoms are due to dehydration. This:

• fatigue;
• nausea and vomiting not associated with food or pregnancy;
• tendency to constipation;
• dry skin and mucous membranes;
• temperature rise;
• may be enuresis.

These are the main symptoms of diabetes insipidus. But the manifestations of the disease may differ slightly in children and adults:

1. Men may also experience symptoms of impotence, decreased libido, or decreased size of the genitals.
2. In women, along with severe thirst and excessive urination, symptoms of menstrual dysfunction appear. Infertility or recurrent miscarriage due to diabetes insipidus may even develop.
3. If the disease develops in children under three years of age, and the severity of diabetes insipidus is not severe, then the disease is indicated by:

• the child drinks water more readily than milk or formula;
• a lot of urine is released, this happens often;
• despite nutrition, the child is losing weight;
• few tears;
• rapid increase or decrease in temperature.

If diabetes insipidus is severe in a child under three years of age, and the copious amount of urine excreted is not corrected, then symptoms of dangerous dehydration can quickly increase:

• dry skin and lips;
• retraction of the fontanelle;
• sunken eyes.

If these signs are not paid attention to, then convulsions and depression of consciousness can quickly develop. If help is not provided, death may occur.

How is the diagnosis made?

Diagnosis of diabetes insipidus begins with a survey of an endocrinologist. He needs to find out how much water the patient drinks per day, what volume of urine is produced, whether thirst is associated with a psychological reason (if a person is engaged in some activity, he forgets to drink water), whether the person drinks at night.

1. Determination of glucose in blood;
2. determination of blood osmolarity;
3. general urine analysis with determination of its osmolarity;
4. analysis according to Zimnitsky;
5. determination of electrolytes, urea, nitrogen in the blood;
6. in women, blood levels of sex hormones, prolactin are determined;
7. Reberg's test;
8. Ultrasound examination of the kidneys;
9. magnetic resonance (or computer) tomography of the brain;
10. X-ray of the skull.

In addition to such tests, the diagnosis of diabetes insipidus consists of several tests:

— Dry eating test: a diet with significant fluid restriction is prescribed for a day or more. Normally, after 6–9 hours, the production of vasopressin is stimulated and the volume of urination is greatly reduced, and 3–5% of weight is lost. If during the test a person feels unwell (symptoms such as nausea, palpitations, weakness, severe thirst appear), the study is stopped. It is not used in children or pregnant women.

— Test with “Minirin” in the form of tablets or drops. Detection of central diabetes insipidus with its help is that while taking this drug, the amount of urine decreases, and its specific gravity increases. If diabetes is nephrogenic, the indicators do not change.

Therapy

Treatment of diabetes insipidus depends on its type and severity. So, if the volume of urine lost in an adult is less than 4 liters per day, only a diet special for diabetes insipidus is prescribed. If more than 4 liters of urine are produced, drug therapy is used.

Drug treatment of diabetes insipidus consists of prescribing:

1. “Minirina” in the form of nasal drops, the dose of which is selected individually. This is a drug that activates vasopressin receptors in the kidneys and is prescribed for any form of diabetes insipidus.
2. If the production of ADH is insufficient, drugs are prescribed that stimulate its production: Miscleron, Carbamazepine, Chlorpropamide.
3. If congenital nephrogenic diabetes insipidus is being treated, diuretics (Lasix, Triampur) and drugs such as Indomethacin or Nurofen are prescribed.
4. Therapy for acquired nephrogenic disease consists of treating the underlying disease.

The diet for illness consists of limiting salt intake and avoiding sweets. The main products are:

• compotes;
• dried fruits (they have a good composition of electrolytes);

Diabetes insipidus is a disease resulting from a deficiency of antidiuretic hormone (vasopressin) or impaired sensitivity of the kidney tissue to it. The main symptoms of the disease are excessive urine production (which is why this condition is called “diabetes”, and the word “insipidus” indicates that there are no problems with blood sugar levels in this disease) and extreme thirst. Diabetes insipidus can be a congenital or acquired disease and affects both men and women. There are many causes of diabetes insipidus. Treatment of the disease consists of replacement therapy with a synthetic analogue of the hormone. From this article you will learn basic information about diabetes insipidus.

Antidiuretic hormone is produced by the cells of the hypothalamus, and then travels through special fibers to the pituitary gland and accumulates there. The hypothalamus and pituitary gland are components of the brain. From the pituitary gland, the hormone is released into the bloodstream, reaching the kidneys with the bloodstream. Normally, antidiuretic hormone ensures that fluid in the kidneys is absorbed back into the bloodstream. That is, not everything that is filtered through the renal barrier is excreted and is urine. Most of the fluid is reabsorbed back. With diabetes insipidus, everything that is filtered is excreted from the body. This results in liters and even tens of liters per day. Naturally, this process creates a strong thirst. A sick person is forced to drink a lot of fluid in order to somehow compensate for its deficiency in the body. Endless urination and the constant need for fluid exhaust a person, which is why the term “diabetes” is synonymous with diabetes insipidus.

Diabetes insipidus is a fairly rare disease: its incidence is 2-3 cases per 100,000 population. According to statistics, the disease equally often affects females and males. Diabetes insipidus can occur at any age. You can be born with it, you can get it in old age, but still the peak incidence occurs in the second or third decade of life. The disease is multifactorial, that is, it has many causes. Let's take a closer look at this point.

Causes of diabetes insipidus

Doctors divide all cases of diabetes insipidus into central and renal. This classification is based on the causes of its occurrence.

Central diabetes insipidus is associated with problems in the hypothalamus and pituitary gland in the brain (that is, “in the center”), where antidiuretic hormone is formed and accumulates; the renal one is caused by the immunity of the excretory organs to the completely normal hormone vasopressin.

Central diabetes insipidus occurs as a result of the formation of an insufficient amount of antidiuretic hormone, a violation of its release, and its blockade by antibodies. Such situations may arise when:

• genetic disorders (defects of genes responsible for the synthesis of vasopressin, defects of the skull in the form, for example, microcephaly, underdevelopment of certain parts of the brain);
• neurosurgical operations (intervention can be carried out for any reason: traumatic brain injury, tumors and other reasons). Anatomical damage occurs to the structures of the hypothalamus or the fibers going from it to the pituitary gland. According to statistics, every 5th case of diabetes insipidus is the result of neurosurgical intervention. However, there are cases of transient (transient) diabetes insipidus after brain surgery; in such cases, the disease goes away on its own at the end of the postoperative period;
• irradiation of the brain for tumor diseases (the tissue of the hypothalamus and pituitary gland is very sensitive to X-rays);
• (destruction of the hypothalamus, pituitary gland, swelling or compression of these areas);
• tumors of the hypothalamic-pituitary region and the area of ​​the sella turcica;
• neuroinfections (,);
• vascular lesions of the hypothalamic-pituitary region (aneurysm, vascular thrombosis and other conditions);
• autoimmune diseases (antibodies are produced that damage those parts of the brain where the hormone is produced and accumulated, or block the hormone itself, rendering it inoperative). This situation is possible with sarcoidosis, tuberculosis, granulomatous lung diseases;
• use of Clonidine (Clonidine);
• for no apparent reason. In such situations they speak of idiopathic diabetes insipidus. It accounts for about 10% of all cases of central diabetes insipidus and develops in childhood.

Sometimes diabetes insipidus appears during pregnancy, but symptoms may go away after pregnancy.

The renal form of the disease is much less common. It is associated with impaired integrity of nephrons (kidney cells) or decreased sensitivity to vasopressin. This is possible with:

• renal failure;
• mutations in the gene responsible for receptors for vasopressin in the kidneys;
• amyloidosis;
• increasing the concentration of calcium in the blood;
• the use of drugs containing lithium (and some others that have a toxic effect on the kidney parenchyma).

Symptoms

In most cases, diabetes insipidus develops acutely. The main manifestations of the disease are the release of large amounts of urine (more than 3 liters per day) and severe thirst. In this case, excess urine is the primary symptom, and thirst is secondary. Sometimes the amount of urine per day can be 15 liters.

Urine in diabetes insipidus has its own characteristics:

• low relative density (specific gravity) - less than 1005 (always, in any portion of urine, regardless of the amount of liquid drunk);
• has no color, does not contain enough salts (compared to normal urine);
• free from pathological impurities (for example, increased levels of leukocytes, the presence of red blood cells).

A characteristic feature of diabetes insipidus is the passage of urine at any time of the day, including at night. The constant urge to urinate makes it impossible to fall asleep and exhausts the patient. Sooner or later, this situation leads to nervous exhaustion of the body. Neuroses and depression develop.

Even if a person is not allowed to drink, a lot of urine will still be produced, leading to dehydration. A diagnostic test is based on this phenomenon to confirm the presence of diabetes insipidus in a patient. This is the so-called dry food test. For 8-12 hours the patient is not given any liquid (including with food). Moreover, in the case of existing diabetes insipidus, urine continues to be excreted in large quantities, its density does not increase, osmolarity remains low, and weight is lost by more than 5% of the original.

The intake of excess urine leads to expansion of the renal pelvis system, ureters and even the bladder. Of course, this does not happen immediately, but over a certain period of illness.

Thirst in diabetes insipidus is a consequence of the loss of huge amounts of fluid in the urine. The body tries to find ways to restore the contents of the bloodstream, and therefore thirst arises. I want to drink almost constantly. A person drinks water in liters. Due to such water overload of the gastrointestinal tract, the stomach is stretched, the intestines are irritated, digestive problems and constipation arise. At first, with diabetes insipidus, the fluid supplied through drinking compensates for losses in the urine, and the cardiovascular system does not suffer. However, over time, fluid deficiency still occurs, blood flow becomes insufficient, and the blood thickens. Then symptoms of dehydration occur. Severe general weakness, dizziness, headache appear, heart rate increases, blood pressure drops, and collapse may develop.

Signs of a chronic lack of fluid in the body with long-term diabetes insipidus include dry and flabby skin, an almost complete absence of sweat, and a small amount of saliva. Weight is invariably lost. I am concerned about the feeling of nausea and periodic vomiting.

In women, the menstrual cycle is disrupted, in men, potency is weakened. Of course, all these changes occur in the absence of adequate treatment for diabetes insipidus.

Treatment

The main principle of treatment for diabetes insipidus is replacement therapy, that is, replenishing the deficiency of the hormone vasopressin in the body by introducing it from the outside. For this purpose, a synthetic analogue of the antidiuretic hormone Desmopressin (Minirin, Nativa) is used. The drug has been used since 1974 and is effective in the treatment of central diabetes insipidus.

There are forms for subcutaneous, intravenous, intranasal (spray, nasal drops) and oral (tablets) use. The most commonly used are spray, nasal drops and tablets. Injectable forms are required only in severe cases or, for example, when treating mentally ill people.

Using the dosage form in the form of a spray or nasal drops allows you to get by with significantly lower dosages of the drug. So, for the treatment of adults, 1 drop or 1 injection into the nose (5-10 mcg) is prescribed 1-2 times a day, and when using tablets, the dose is 0.1 mg 30-40 minutes before meals or after 2 hours after meals 2-3 times a day. On average, it is generally accepted that 10 mcg of the intranasal form is equivalent to 0.2 mg of the tablet form.

Another nuance of using nasal drops or spray is that it works faster. For colds or allergic diseases, when the nasal mucosa swells and adequate absorption of the drug is impossible, spray or drops can be applied to the oral mucosa (the dose is doubled).

The dose of the drug depends on how much antidiuretic hormone the patient produces and how severe its deficiency is. If the hormone deficiency is, for example, 75%, this is one dose, if 100% (complete absence of the hormone) is another. The selection of therapy is carried out individually.

You can partially increase the synthesis and secretion of your own antidiuretic hormone with the help of Carbamazepine (600 mg per day), Chlorpropamide (250-500 mg per day), Clofibrate (75 mg per day). Daily doses of drugs are divided into several doses. The use of these drugs is justified in partial diabetes insipidus.

Adequate replacement therapy for diabetes insipidus with Desmopressin allows a person to lead a normal lifestyle with few restrictions (this applies to diet and drinking). In this case, complete preservation of working capacity is possible.

Renal forms of diabetes insipidus do not have developed and proven treatment regimens. Attempts are being made to use hypothiazide in large doses, non-steroidal anti-inflammatory drugs, but such treatment does not always give a positive result.

With diabetes insipidus, patients should adhere to a certain diet. It is necessary to limit protein intake (to reduce the load on the kidneys), and increase the content of foods rich in fats and carbohydrates in the diet. The diet is divided: it is better to eat more often and in smaller portions to ensure the absorption of food.

Separately, the water load should be noted. Without adequate fluid replacement, diabetes insipidus causes complications. But it is not recommended to replenish fluid loss with plain water. For this purpose, it is necessary to use juices, fruit drinks, compotes, that is, drinks rich in minerals and trace elements. If necessary, the water-salt balance is restored using intravenous infusions of saline solutions.

Thus, diabetes insipidus is the result of a deficiency of antidiuretic hormone in the human body for various reasons. However, modern medicine makes it possible to compensate for this deficiency with the help of replacement therapy with a synthetic analogue of the hormone. Competent therapy returns a sick person to the mainstream of a full life. This cannot be called a complete recovery in the literal sense of the word, however, in this case, the state of health is as close as possible to normal. And this is no longer enough.

Channel One, “Health” program with Elena Malysheva on the topic “Diabetes insipidus: symptoms, diagnosis, treatment”:

Diabetes insipidus is a syndrome caused by a lack of vasopressin in the body, which is also defined as antidiuretic hormone. Diabetes insipidus, the symptoms of which are impaired water metabolism and manifest as constant thirst with simultaneous increased polyuria (increased urine production), is, however, a rather rare disease.

general description

The development of diabetes insipidus occurs due to the relevance of pathologies of the pituitary gland, which, in turn, arise due to malignant or benign metastatic tumors. Among other possible causes of the formation of destructive processes, unsuccessful surgical interventions affecting the brain are also noted. Thus, in every fifth case, diabetes insipidus occurs precisely because of unsuccessful neurosurgical surgery.

Diabetes insipidus is not a hereditary disease, but some autosomal recessive inherited syndromes (for example, Wolfram's disease, complete diabetes insipidus or incomplete diabetes insipidus) are part of the clinical picture indicating a genetic mutation.

As we have already noted, diabetes insipidus is a fairly rare disease, which represents only about 0.7% of the total number of actual endocrine pathologies. There is an equal incidence rate among both sexes. As for childhood morbidity, in this case, diabetes insipidus often manifests itself in a congenital form, and its diagnosis can be made quite late - often this happens around or even after 20 years. Among adults, acquired diabetes mellitus is most often diagnosed.

Diabetes insipidus: classification

In addition to the above-mentioned congenital and acquired forms, there are such varieties of the disease as central diabetes insipidus, renal diabetes insipidus and idiopathic diabetes insipidus.

Central diabetes insipidus

The development of central or hypothalamic-pituitary diabetes insipidus occurs due to the inability of the kidneys to accumulate fluid. This pathology occurs due to disturbances that occur in the functions of the distal tubules of the nephron. As a result, a patient with this form of diabetes insipidus suffers from frequent urination in combination with polydipsia (that is, unquenchable thirst syndrome).

It should be noted that if the patient has the opportunity to consume unlimited water, then there are no threats to his condition. If for one reason or another there is no such opportunity, and the patient cannot quench his thirst in time, he rapidly begins to develop dehydration (or hyperosmolar dehydration). Reaching the extreme stage of this syndrome is life-threatening for the patient, because the next stage is the transition to hypersomolar coma.

The long-term course of central diabetes insipidus for the patient develops into renal insensitivity to the antidiuretic hormone artificially administered for therapeutic purposes. For this reason, the sooner treatment for this form of diabetes insipidus begins, the more favorable the prognosis for the patient’s subsequent condition becomes.

It should also be noted that significant volumes of fluid consumed by the patient can cause the appearance of conditions accompanying this disease, such as biliary dyskinesia, the development of irritable bowel syndrome or gastric prolapse.

Idiopathic diabetes insipidus

The incidence of diabetes insipidus in this form accounts for a third of cases. Here, in particular, we are talking about the absence of any types of organic pathologies of the organ during diagnostic imaging of the pituitary gland. In other words, the reported incidence of diabetes insipidus is unknown. In some cases, it can be passed on by inheritance.

Renal diabetes insipidus

Diabetes insipidus in this form is provoked by organic or receptor pathologies of the kidneys, including enzymatic enzymes. The form is quite rare, and if it is observed in children, then, as a rule, in this case it is congenital. It is caused by mutations in the aquaporin-2 gene or mutations in the vasopressin receptor. If we are talking about the acquired form of morbidity in adults, then it is advisable to note as the cause renal failure, which provokes this form of diabetes, regardless of the characteristics of its etiology. In addition, renal diabetes insipidus can also occur as a result of long-term therapy using lithium preparations and other specific analogues.

Symptoms of diabetes insipidus

The main symptoms of diabetes insipidus, as we have already highlighted, are polyuria (that is, frequent urination), as well as polydipsia (thirst syndrome). As for the severity of these manifestations, we can talk about their different intensities.

Dwelling on the features of symptoms, it should be noted that polyuria manifests itself in an increase in the total volume of urine excreted per day (which is most often about 4-10 liters, and in some cases can reach up to 30 liters). The excreted urine is colorless, it contains a small amount of salts and other types of elements. All portions are characterized by low specific gravity.

An unquenchable feeling of thirst in the case of actual diabetes mellitus leads, accordingly, to polydipsia, in which significant volumes of fluid are consumed, in some cases they can be equal to the volume of urine lost.

The severity of diabetes insipidus itself in the complex is characterized by the degree of lack of antidiuretic hormone in the body.

The development of the idiopathic form of diabetes insipidus occurs extremely acutely and suddenly; in rare cases, the course of the process is determined by a gradual increase. Pregnancy can lead to the manifestation of the disease (that is, to the development of the severity of its characteristic clinical manifestations following an erased or asymptomatic form of the course).

Due to the frequent occurrence of the urge to urinate (which is defined as pollakiuria), sleep disturbances and (i.e., mental state disturbances) appear, and increased physical fatigue and emotional imbalance are also noted. The early manifestation of diabetes insipidus in children is expressed in, subsequently the manifestations of the disease are accompanied by delays in growth and puberty.

Late manifestations of the disease include dilations that occur in the renal pelvis, bladder and ureters. Due to significant water overload, overdistension of the stomach and its prolapse occurs; in addition, the development of biliary dyskinesia and chronic intestinal irritation are also noted.

Patients with diabetes insipidus experience significant dry skin and secretion of saliva and sweat. Appetite is reduced. Somewhat later, such manifestations as dehydration, headaches, vomiting, weight loss, and low blood pressure appear. Diabetes insipidus, caused by damage to parts of the brain, occurs with the development of neurological disorders, as well as with symptoms indicating pituitary insufficiency.

In addition to the listed symptoms, diabetes insipidus occurs in men and menstrual irregularities in women.

Complications of diabetes insipidus

The danger of diabetes insipidus lies in the risk of developing dehydration of the body, which occurs in situations in which the loss of fluid from the body through urine is not adequately replenished. For dehydration, characteristic manifestations are general weakness and tachycardia, vomiting, and mental disorders. Blood thickening, neurological disorders and hypotension, which can reach a state of collapse, are also noted. It is noteworthy that even severe dehydration is accompanied by persistence of polyuria.

Diagnosis of diabetes insipidus

Diagnosis of diabetes insipidus requires an appropriate test for polyuria. In a normal state of the body, the volume of urine excreted per day does not exceed three liters. Accordingly, patients with diabetes insipidus exceed this indicator; in addition, there is also a low degree of density of urine excreted.

Another test is used to diagnose diabetes insipidus, which is defined as a dry eating test. In this case, the patient must refrain from drinking for eight hours. With a sharp decrease in weight over a given period of time and a urine density of no more than 300 mOsm/liter, the diagnosis of “diabetes insipidus” is confirmed.

The differential diagnosis of diabetes insipidus involves excluding the insulin-dependent form of diabetes, as well as the presence of tumors in the hypothalamic-pituitary region, neurotic and mental disorders and kidney pathologies of an organic nature.

Treatment of diabetes insipidus

If we are talking about the need to treat a symptomatic type of diabetes insipidus, that is, diabetes insipidus that has arisen as one of the symptoms of a particular type of disease, then therapy focuses primarily on eliminating the root cause (for example, a tumor).

Regardless of the form of diabetes insipidus, patients are prescribed replacement therapy using a synthetic analogue of antidiuretic hormone (ADH). The use of this kind of drugs is carried out orally or by instillation of the nose. Long-acting medications are also used. The central form of diabetes insipidus involves the prescription of drugs whose action stimulates the secretion of ADH.

Additionally, a correction is carried out aimed at replenishing the water-salt balance, for which saline solutions are injected in significant volumes. The use of diuretics seriously reduces diuresis.

As for the nutritional features in the treatment of diabetes insipidus, it involves limiting protein intake, which helps reduce the load on the kidneys. In addition, the consumption of fats and carbohydrates should be sufficient. Food should be taken frequently, and emphasis is placed on increasing the total amount of fruit and vegetable dishes consumed. To quench your thirst, it is recommended to consume compotes, fruit drinks and juices.

To diagnose diabetes insipidus, if characteristic warning symptoms appear, you must contact an endocrinologist.

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