Causes of diabetes insipidus. Diabetes insipidus, symptoms and treatment

Diabetes insipidus is a disease of the endocrine system, which is accompanied by excessive urination and thirst. Its other names are “diabetes”, “renal diabetes”. Most often, the disease is diagnosed in women over 40 years of age. Although the main symptoms are similar to those diabetes mellitus, these are different ailments.

Causes

The development of diabetes insipidus is not associated with changes in blood glucose levels; in this disease, the regulation of the processes of urine formation and urination is impaired. U Patients develop an unquenchable thirst, and the amount of urine produced increases. Limiting water intake causes dehydration, a person may lose consciousness or fall into a coma.

There are several forms of the disease:

1. Central. Develops for a reason insufficient production hypothalamus of the antidiuretic hormone vasopressin.
2. Renal. The reason is a decrease in the sensitivity of kidney tissue to vasopressin. Disorders may be genetic or result from damage to the nephrons.
3. Dipsogenic. Constant drinking of liquid is caused by damage to the thirst regulation mechanism in the hypothalamus. This form of diabetes sometimes develops due to mental disorder.

Central diabetes insipidus is divided into idiopathic and symptomatic. Idiopathic is caused by hereditary pathologies accompanied by a decrease in the production of antidiuretic hormone (ADH).

Symptomatic (acquired) is observed against the background of certain diseases:

The disease is sometimes detected after neurosurgical intervention.

Causes of the renal (nephrogenic) form:

Some women develop diabetes insipidus during pregnancy, which is called gestational diabetes.

Pathology develops due to the destruction of the blood pressure hormone by substances produced by the placenta. In 30% of patients, the cause of the disorders cannot be determined.

Symptoms of diabetes insipidus

The disease is characterized by rapid development, but sometimes it intensifies gradually. Initial signs Diabetes insipidus is no different in both men and women - it is a strong thirst, frequent urination. The patient drinks 5-20 liters of water per day (the norm is 1.5-2 liters).

Violations of the water-electrolyte balance give impetus to further deterioration of the condition.

Diabetes insipidus can be recognized by its characteristic symptoms:

The patient's performance is greatly reduced and psychoemotional disorders (insomnia, irritability) are observed. One of the symptoms of diabetes insipidus in women can be a disturbance in the menstrual cycle.

The disease sometimes leads to infertility, in pregnant women - to a miscarriage. In men, diabetes insipidus causes impotence.

In children over 3 years of age, the pathology manifests itself in the same way as in adults, but often its signs are not clearly expressed. The main manifestations include:

In newborns and infants up to 1 year of age, the symptoms of diabetes insipidus are:

Instead of mother's milk, the child prefers to drink water. With absence medical care The baby's condition is rapidly deteriorating. Seizures develop, which can be fatal.

Diagnostics

If you suspect diabetes insipidus, you should contact an endocrinologist. Patients additionally visit a neurosurgeon, a neuropathologist, an oculist. Women should consult a gynecologist.

Some research will need to be done. To identify diabetes insipidus:

Laboratory tests will assess the osmolarity of the blood, relative density and urine osmolarity. Bio chemical analysis blood makes it possible to obtain data on the level of glucose, nitrogen, potassium, sodium and other substances.

Diagnostic indicators of the disease:

Diabetes insipidus and diabetes mellitus are easy to distinguish. In the first case, sugar is not detected in the patient’s urine, and the level of glucose in the blood does not exceed the norm. The ICD-10 disease code is E23.2.

Treatment

Treatment of symptomatic diabetes insipidus begins with identifying and eliminating the cause of the pathology. To normalize the water-salt balance, the patient is given intravenous drip infusions of saline solutions. This will prevent the development of dehydration.

Replacement treatment is required. The patient is prescribed a chemical analogue of antidiuretic hormone (desmopressin).

There are several forms of such medications:

The daily amount is selected depending on the condition of the body, the type of drug, on average it is:

1. Tablets for oral administration - 0.1-1.6 mg;
2. Sublingual tablets - 60-360 mcg;
3. Spray for intranasal use - 10-40 mcg.

When prescribing Adiuretin, it is first necessary to determine the body's reaction to the medicine; for this purpose, 1-2 drops are instilled into the nose in the evening or at night. facilities. Subsequently, the dose is increased until the urinary process normalizes.

Other drugs for replacement treatment:

Drugs are used that improve the production of vasopressin and its entry into the blood. These include:

1. Chlorpropamide (hypoglycemic agent). It is taken at 0.125-0.25 g 1-2 times a day.
2. Miskleron (antiatherogenic agent). Prescribe 2 capsules 2-3 times a day.

Such drugs are ineffective in the nephrogenic form of the pathology.

Such patients are prescribed diuretics, which have a paradoxical effect: they weaken filtration, the amount of urine excreted drops by 50-60%. The patient may be prescribed hypothiazide, daily amount is 25-100 mg.

Combined diuretics (Amiloretic, Isobar) are also effective. During treatment, it is necessary to reduce the amount of salt consumed (up to 2 g/day). Additionally, prostaglandin synthesis inhibitors (Ibuprofen, Indomethacin) are prescribed.

In children, treatment of diabetes insipidus also involves prescribing medications containing desmopressin. The dose must be selected by the attending physician. While taking medications, it is necessary to perform a urine test to monitor the relative density indicator.

If a dipsogenic form is detected, diuretics or drugs containing desmopressin are contraindicated for the patient. Such drugs provoke severe water intoxication. Therapeutic measures consist of reducing fluid intake.

A diet is required; the amount of protein and salt in the menu is reduced and the consumption of fermented milk products, vegetables, and fruits is increased.

In women, the menstrual cycle is corrected. The gestational form that appears during pregnancy is treated like the central one, i.e., the drug desmopressin is prescribed. To prevent dehydration, you should always carry water with you, but it is recommended to drink less during the day.

The rate of fluid intake should be determined by the attending physician.

Diet for diabetes insipidus

A diet for diabetes insipidus should be selected by a specialist. Medical nutrition is an important part of therapy. Its goal is to reduce the volume of fluid secretion and replenish nutrients.

Eat food more often (up to 5-6 rubles/day), in small portions. Limit the amount of salt (up to 5-6 g/day). Add it to ready-made dishes, and do not add salt to food during cooking. It is important to increase your carbohydrate intake. Include vegetables, herbs, and fruits in your menu. You can cook pasta and potato dishes. Fats (vegetable and animal) are also necessary.

To maintain brain function, you need to eat foods high in phosphorus ( lean fish, seafood). Eat dried fruits, they are rich in potassium, which improves the synthesis of AHD. It is good to drink fruit drinks, freshly squeezed juices, compotes (preferably homemade).

Include lean meat, dairy, dairy products, however, the protein content in the diet still needs to be reduced, since such food puts a strain on the kidneys. Avoid sweets, they increase thirst.

Recipes traditional medicine will help eliminate the symptoms of diabetes insipidus. Prepare an infusion of burdock roots that will significantly reduce thirst.

You will need the following ingredients:

Grind the burdock root and place it in a thermos. Add boiling water and leave for 10-12 hours. You can prepare the infusion in the evening and drink it in the morning. Recommended dose – 150 ml (3 times/day).

A drink made from leaves is a good thirst reliever. walnut. Ingredients:

Fill the raw material with water after 15 minutes. strain. Use the drink instead of tea. Do not exceed the maximum daily dose, which is 1 liter.

To normalize the process of synthesis of blood pressure hormones, use elderberry infusion. To prepare it you will need:

It is better to prepare the product in a thermos, leaving it for 1 hour. Strain the drink, dissolve 1 table. l. honey. Take the infusion 3 times a day in equal doses. The course of treatment will be 1 month. After 10 days. The medication can be repeated.

To eliminate sleep disturbances and thirst, prepare an infusion with a sedative effect.

The following ingredients will be required (in equal quantities):

Mix all ingredients, place 1 table in a thermos. l. raw materials, brew with 1 glass of warm water (85 °C). After an hour, you can drink the drink. Take 80 ml of it half an hour before going to bed. The course of admission is up to 3 months.

Some doctors prescribe herbal teas How complementary therapy To medicines, however folk remedies cannot be used as primary treatment. Before using any infusions or decoctions, it is recommended to consult a specialist.

Forecast

Gestational diabetes insipidus in women, which develops during pregnancy, goes away after childbirth.

In other forms, for example, idiopathic, recovery is rare, but replacement therapy will allow patients to remain able to work. If the main cause of the disease is identified and eliminated, the treatment will be successful.

Diabetes insipidus is a syndrome caused by a lack of vasopressin in the body, 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 others possible reasons formation of destructive processes, unsuccessfully performed surgical interventions, affecting the brain. 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% total number current 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 patient's long-term course of central diabetes insipidus develops into renal insensitivity to artificially administered drugs. medicinal purposes antidiuretic hormone. 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 dyskinesia biliary tract, development of irritable bowel syndrome or prolapse of the stomach.

Idiopathic diabetes insipidus

The incidence of diabetes insipidus in this form accounts for a third of cases. Here in particular we're talking about 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 characteristics of the 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. To the manifestation of the disease (that is, to the development of the severity of its characteristic clinical manifestations after an erased or asymptomatic form of the course) can lead to pregnancy.

In view of frequent occurrence urge to urinate (which is defined as pollakiuria), sleep disturbances and (i.e. disturbance mental state), increased physical fatigue and emotional imbalance are also noted. early manifestation 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 enlargements that occur in 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, mental disorders. Blood clots are 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.

Diagnosis of diabetes insipidus

Diagnosis of diabetes insipidus requires an appropriate test for polyuria. At in good condition 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.

IN differential diagnosis Diabetes insipidus requires the exclusion of 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

When it comes to the need for treatment symptomatic type diabetes insipidus, that is, diabetes insipidus that has arisen as one of the symptoms of one or another 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, correction is carried out aimed at replenishing water-salt balance, why they are infused saline solutions 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 total number consumed fruit and vegetable dishes. 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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Diseases with similar symptoms:

Diabetes mellitus is chronic illness, in which the functioning of the endocrine system is affected. Diabetes mellitus, the symptoms of which are based on a prolonged increase in the concentration of glucose in the blood and on the processes accompanying an altered metabolic state, develops in particular due to a deficiency of insulin, a hormone produced by the pancreas, due to which the body regulates the processing of glucose in the tissues of the body and in his cells.

Irritable bowel syndrome (IBS) is a range of functional disorders related to the work of all lower sections digestive tract. It is otherwise called irritable bowel syndrome, but she is not the only one who suffers. This problem occurs in half of the world's population, and affects both the elderly and children. Irritable bowel syndrome most often occurs in women.

Kidney failure refers to a syndrome in which all functions relevant to the kidneys are disrupted, resulting in a disorder various types exchanges in them (nitrogen, electrolyte, water, etc.). Renal failure, the symptoms of which depend on the course of this disorder, can be acute or chronic, each of the pathologies develops due to the influence of different circumstances.

As a result of disruption of the kidneys, maintaining water-salt and basic acid balances in the body, renal diabetes develops. With this disease, there is an increased amount of glucose in the urine. Variety pathological process is renal diabetes insipidus, which appears due to problems arising in the reabsorption of fluid in the kidneys.

Poor blood circulation and its composition negatively affects kidney health.

General information for children and adults

Diabetes occurs as a result of improper functioning of the kidneys and a deficiency of the hormone vasopressin, which is directly involved in the formation of urine, affecting its concentration and density. Violation of the normalization of urination is characterized by the emission of copious amounts of fluid processed by the body in a sufficiently diluted form. Renal pathology This type is one of the rare diseases and can develop in adults and children, and in women during pregnancy.

Types of diabetes

There are several classifications of kidney diabetes insipidus. Typologies differ in the criterion taken as the basis for identifying different types of this pathology. Depending on the level at which the deviation occurs, the following types of diabetes are determined:

1. Central (hypothalamic) - associated with impaired formation and release of vasopressin. The result of problems with antidiuretic hormone is an increase in urinary fluid excretion with a decrease in its relative density:
   • idiopathic - affects low vasopressin production hereditary pathology in the central nervous system;
   • symptomatic - the causes of occurrence are various diseases brain (trauma, tumors, infectious inflammation).
2. Nephrogenic (renal) - the disease originates at the level of renal tissues, in which sensitivity to the effects of antidiuretic hormone is impaired:
   • congenital - due to the presence in a person kidney disease from the moment of his birth;
   • acquired - the main condition for its appearance is drug-induced damage to kidney cells.
3. Progestational - the disease is characteristic of women; the conditions for its development are pregnancy, during which the activity of the placental enzyme increases, which has a destructive effect on vasopressin.
4. Functional - diabetes insipidus, typical for children in early age, which is associated with the immaturity of the kidneys, their difficult work in the mechanism of sputum concentration.

Renal pathology is considered depending on the complexity of its course without taking into account the use medicines. As an indicator, the amount of daily urine output is chosen, in relation to which diabetes insipidus can be of such degrees as mild, moderate and severe. The accompanying form of this pathology in endocrinology includes polydipsia ( constant desire drink).

Causes of renal diabetes insipidus

The variety of factors influencing the occurrence of renal diabetes insipidus depends on its type. The main reasons for the formation of pathology at the level of central origin include:

• lesions and injuries of the brain or skull;
• tumor formation and metastases in the pituitary gland and hypothalamus;
• postoperative complications in the central nervous system;
• inflammation of the brain;
• disturbances in the blood supply to the pituitary gland;
• consequences after infectious diseases;
• syphilis;
• congenital genetic defects.

Among the causes of nephrogenic diabetes are:

• pathologies and conditions affecting kidney damage;
• an increase in the amount of potassium in the blood and a decrease in calcium;
• spread of cystic formations;
• chronic renal failure;
• drugs with toxic effects on renal tissue;
• pathologies at the gene level.

Pathogenesis

Features of the formation and development of diabetes insipidus are determined by its types. Depending on the focus of kidney pathology, consideration is given to distinctive features course of the disease. With central diabetes, damage to the hypothalamus occurs, resulting in a disruption in the production of antidiuretic hormone, which is involved in the formation of urine. Nephrogenic diabetes insipidus occurs when the renal tissues lack the ability to perceive vasopressin. Acquired forms of pathology can develop against the background of chronic kidney disease, problems with the metabolism of calcium and potassium in the body, and brain injuries.

General symptoms

The main signs of the appearance and development of renal diabetes insipidus in the body are characterized by changes in the functioning of the excretory system, aimed at purifying fluid and producing sputum. In this regard, consider such symptoms inherent in all types of diabetes as (exceeding daily norm urination) and polydipsia (excessive fluid intake). At the same time, urine analysis shows its discoloration, a decrease in concentration and the absence of salts. Negative changes in the functioning of the kidneys lead to unstable sleep, emotional imbalance, neuroses and constant fatigue.

Primary signs

In the symptoms of diabetes insipidus, attention is paid to the manifestation of the disease at its initial stage. Excruciating thirst and heavy urination are accompanied by a general deterioration in the person’s condition. Early signs renal diabetes insipidus are diagnosed during the first week of their manifestation. Among them are:

• the appearance of headache;
• loss of appetite;
• significant weight loss;
• the appearance of a gag reflex;
• decreased salivation;
• stomach distension;
• regular constipation;
• noticeable dryness of the skin.

During this period, the amount of urea exceeds the norm in the body, which is sometimes accompanied by skin itching. To the number primary signs also includes hyperkalemia, which characterizes an increase in potassium concentration in the blood. As a result, there is a danger of dehydration. If such a set of indicators is present, immediate consultation with a doctor and treatment is necessary. As renal diabetes insipidus becomes more complicated, the patient may experience dry mouth, gastritis, and suffer from instability of weight, temperature, and appetite.

In the symptom complex of kidney insipidus, disorders at the level of mental and emotional manifestation. During the course of the disease, headaches, insomnia, psychosis, irritability appear, and also decreases mental activity. An unstable perception of reality is caused by constant thirst and excessive urination, which continue at night.

Typical symptoms of diabetes insipidus include all the above signs and differs among women, men and children. Representatives of the stronger sex have additional negative consequence The development of the disease becomes a decrease in potency and libido. In women, at the same time the usual signs sometimes the menstrual cycle is disrupted, infertility develops, and in case of pregnancy, a miscarriage occurs.

Diabetes insipidus is a relatively rare disease that is characterized by severe thirst and excretion excess quantity urine (polyuria).

In most cases, diabetes insipidus is the result of impaired synthesis, accumulation and release of antidiuretic hormone (ADH).

But diabetes insipidus can also occur when the kidneys are unable to respond to the action of this hormone. Less commonly, diabetes insipidus occurs during pregnancy (gestational diabetes insipidus).

Many people confuse this disease with the similar term “diabetes mellitus”. But apart from the name, diabetes insipidus and diabetes mellitus (types 1 and 2) have absolutely nothing in common.

Modern treatment for diabetes insipidus is aimed at eliminating the root cause, alleviating thirst and normalizing urine output.

Causes of diabetes insipidus

If the kidneys are working correctly, then they finely regulate the balance of fluid in the body - if we drink a lot and lose little fluid, then more urine is produced, and if we are dehydrated, then the kidneys reduce urine production to conserve water. The volume and composition of body fluids remains constant due to this important mechanism.

The rate of fluid intake is mainly dictated by the feeling of thirst, although our habits may cause us to drink more water than we need. But the rate of fluid excretion is influenced by antidiuretic hormone (ADH), also called vasopressin.

Antidiuretic hormone (vasopressin) is produced in the hypothalamus and accumulates in the pituitary gland - small but very important structure at the base of the brain, which regulates key processes in our body. Antidiuretic hormone is released into the bloodstream when needed. It concentrates urine, affecting the reabsorption of water in the tubules of the filtering apparatus of the kidneys.

Diabetes insipidus can occur as a result of various disorders:

Central diabetes insipidus is usually caused by damage to the pituitary gland or hypothalamus. It can be caused by brain surgery, trauma, tumor, meningitis and other central nervous system disease. In some cases, the cause remains unknown. A damaged hypothalamic-pituitary axis is responsible for impaired production, storage and release of ADH. Often this disease is accompanied by other problems, because the pituitary gland controls many body functions.

Nephrogenic diabetes insipidus occurs due to a defect in renal tubules- structures where water reabsorption occurs. This defect makes the kidneys insensitive to ADH. This pathology can be either hereditary (genetic) or acquired as a result of chronic illness kidneys. Some medications, such as lithium salts and tetracycline, can also cause nephrogenic diabetes insipidus.

Gestational diabetes insipidus occurs only during pregnancy, when produced by the placenta (system blood vessels for blood supply to the fetus) the enzyme destroys maternal ADH.

This form of diabetes insipidus is better known as primary polydipsia or psychogenic polydipsia. In this disease, excessive fluid intake leads to suppression of the effect of antidiuretic hormone. Chronic, uncontrolled drinking of fluids may be the result of a mental disorder (for example, obsessive-compulsive disorder - OCD) or damage to the thirst regulation mechanism in the hypothalamus (for example, sarcoidosis).

In some cases, the cause of diabetes insipidus cannot be determined, despite a comprehensive examination of the patient.

Risk factors for diabetes insipidus

Symptoms of diabetes insipidus

Intense thirst (polydipsia).
. Excessive excretion of urine (polyuria).
. Insufficiently concentrated, light urine.

Depending on the severity of the disease, a person can excrete from 3 liters of urine daily for mild diabetes insipidus to 15 (!) liters for severe illness. Nocturia is also characteristic - patients get up at night in order to urinate. In some cases, they may urinate directly into the bed (incontinence).

Unlike mental illness which are accompanied obsession drink water constantly; with diabetes insipidus, patients wake up even at night, tormented by thirst.

In young children, diabetes insipidus may present with the following symptoms:

Unexplained restlessness and constant crying.
. Unusually fast diaper filling.
. Increased body temperature.
. Vomiting and diarrhea.
. Dry skin.
. Cold extremities.
. growth retardation.
. Weight loss.

With unusual thirst and increased excretion urine, you should consult a doctor. The sooner it is delivered correct diagnosis, the sooner the doctor can start treatment, and the less risk complications.

Diagnosis of diabetes insipidus

The following methods are used to diagnose diabetes insipidus:

This procedure helps determine the cause of diabetes insipidus. You will be asked to stop drinking liquids 2-3 hours before the test. The doctor will determine your weight, urine volume and composition, and blood ADH levels during this period. In children and pregnant women, this test is recommended to be carried out under strict supervision so that fluid loss does not exceed 5% of the initial body weight.

2. Urine tests.

This is a complete physical and chemical analysis of urine. If the urine is not concentrated enough (that is, it contains less salts than normal), then this may speak in favor of diabetes insipidus.

3. Magnetic resonance imaging (MRI).

An MRI of the head is a non-invasive procedure that allows the doctor to obtain a highly detailed image of your brain and all its structures. The doctor will be interested in the area of ​​the pituitary gland and hypothalamus. Diabetes insipidus can be caused by a tumor or injury in this area, as an MRI will show.

4. Genetic screening.

If the doctor suspects hereditary diabetes insipidus, he will need to examine the family history and also conduct genetic testing.

Treatment of diabetes insipidus

Treatment options for different types of disease may include:

With this type of disease, which is accompanied by ADH deficiency, treatment consists of taking a synthetic hormone - desmopressin. The patient can take desmopressin in the form of a nasal spray, tablets or injection. The synthetic hormone will reduce excess urination.

For most patients with this diagnosis, desmopressin is effective and safe choice. While taking desmopressin, you should only drink liquids when you are really thirsty. This requirement is because the medicine prevents the body from losing water, causing the kidneys to produce less urine.

In mild cases of central diabetes insipidus, you may only need to reduce your fluid intake. The doctor can regulate daily intake liquids - for example, 2.5 liters per day. This amount is individual and should ensure normal hydration!

If the disease is caused by a tumor or other abnormalities of the hypothalamic-pituitary system, the doctor will recommend treating the original disease.

2. Nephrogenic diabetes insipidus.

This disease is the result of an abnormal response of the kidneys to antidiuretic hormone, so desmopressin will not work here. The doctor will prescribe a diet low content table salt to help the kidneys reduce urine production.

The drug hydrochlorothiazide (Hypothiazide), given alone or with other medications, may relieve symptoms. Hydrochlorothiazide is a diuretic (usually used to increase urine output), but in some cases it reduces urine output, as in the case of nephrogenic diabetes insipidus. If the symptoms of the disease do not go away despite taking medications and diet, stopping the medications may help.

But without prior permission from your doctor, you should not reduce doses or stop taking any medications!

3. Gestational diabetes insipidus.

Treatment for most cases of diabetes insipidus in pregnancy is with the synthetic hormone desmopressin. In rare cases, this type of disease is caused by an abnormality in the mechanism responsible for thirst. Then desmopressin is not prescribed.

4. Dipsogenic diabetes insipidus.

Does not exist specific method treatment of this type of diabetes insipidus. However, with a number of mental disorders treatment by a psychiatrist will force the patient to reduce fluid intake and alleviate the symptoms of the disease.

Your doctor will recommend that you drink a certain amount of fluid daily to avoid dehydration. Keep water with you wherever you go, especially if you are going to long journey. Children should be offered water every 2 hours, day and night.

2. Wear a warning sign.

In the West, it is common practice to wear special bracelets or cards with a medical warning in your wallet. This will help the doctor quickly navigate if something happens.

Complications of diabetes insipidus

Diabetes insipidus causes dehydration of the body, which impairs the functioning of many organs. This does not apply only to dipsogenic diabetes insipidus, in which patients initially drink a lot of fluids.

Signs of dehydration include:

2. Electrolytic imbalance.

Diabetes insipidus can also cause electrolyte imbalance in the body. Electrolytes are minerals, such as sodium, potassium, calcium, which maintain fluid balance and correct work our cells.

Symptoms of an electrolytic imbalance include:

3. Excess fluid.

With excessive water consumption (dipsogenic diabetes insipidus), so-called water poisoning is possible. It results in low sodium levels in the blood (hyponatremia), which can lead to brain damage.

Konstantin Mokanov

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-Yes, you have diabetes, my friend!
-How did you guess?
-And your fly is unbuttoned, and a bee flies nearby!
(bearded medical joke)

Everyone knows the word “diabetes”. But few know what it means, and very few can explain how diabetes mellitus differs from diabetes insipidus. The time has come to fill this gap. The joke that became the epigraph mentions a bee that flies for something sweet. Folk wisdom I noticed a sign of diabetes: glucosuria (bee), that is, there is an increased amount of sugar in the urine.

Normally, sugar from the blood is utilized in the tissue by the hormone insulin, which is produced by the pancreas. But if there is little of it, or none at all, or the tissues are insensitive to its “work,” then the blood initially contains increased amount sugar, and then it all goes into the urine.

Therefore, the word “diabetes” is an abbreviation of the Latin “diabetes mellitus”, which means “passed through honey”. After all, doctors of the Renaissance, modern times, and even in the 19th century, did not have the means laboratory diagnostics, and were forced to taste the patient's urine. Perhaps that is why the visit of a certified doctor has always cost a lot. big money in ancient times.

But how can this be? How then can diabetes be "diabetes insipidus"? That is, urine containing glucose does not contain it? What should I do? In fact, there is no logical contradiction here. Just the second symptom of diabetes is polyuria, that is, an increased volume of urine that is released during the day.

It was based on this similarity that the disease was called “diabetes insipidus”, or even “diabetes insipidus”. What kind of disease is this? How often does it occur, and how is it treated?

Diabetes insipidus - what is it?

diabetes insipidus symptoms in men photo 1

Diabetes insipidus is endocrine disease in which the kidneys lose their ability to concentrate urine. This condition occurs due to a lack of antidiuretic hormone, and the main symptoms of this disease are:

1. Selection large quantity“diluted” urine;
2. Intense thirst associated with loss of fluid.

To be fair, it must be said that the normal rate of formation primary urine(i.e. blood plasma filtration) is 100 ml/minute. This means that 6 liters of urine are produced in an hour, and 150 liters per day, or 50 three-liter jars!

But 99% of this urine, which contains the necessary substances, undergoes reverse reabsorption in the renal tubules. This activity is regulated by the pituitary hormone, which plays a central role in water salt metabolism organism. It is called an antidiuretic hormone (that is, it reduces diuresis, or the daily amount of urine) in humans.

The incidence of this disease is the same in both men and women, and in children, but it is much less common than regular diabetes. Young people are most often affected.

How does it all work?

Antidiuretic hormone, or vasopressin, is part of a complex regulatory system in which arterial pressure, vascular tone, the volume of fluid in the body and the amount of sodium are intricately interconnected into a single “knot” called the renin–angiotensin–aldosterone system (RAAS).

So, if blood flow in the kidneys decreases (pressure has dropped, blood sodium has decreased), then in the glomeruli of the kidneys, in response to the signal, a special substance is produced - renin. It triggers a cascade of transformation of blood plasma proteins, angiotensin is formed, which reduces the lumen of blood vessels. As a result, the pressure is restored.

Vasopressin, or antidiuretic hormone (ADH), is produced in the brain in order to control the functioning of this system. It reduces the amount of urine produced by increasing the absorption of water back into the bloodstream. Roughly speaking, there are special “hatches” in the renal tubules, when opened, water from the primary urine returns back into the blood. And to open thousands of “latches” on these hatches, vasopressin molecules, or ADH, are needed.

Now we understand (very superficially) the function of vasopressin and its role in regulating kidney function, and we can understand what forms of diabetes insipidus exist. Now even a non-specialist can easily understand that there are two main forms of the disease: central and peripheral.

Central diabetes insipidus

symptoms of diabetes insipidus in women

Central diabetes insipidus occurs if the “center,” that is, the brain, for some reason does not release the hormone into the blood, or there is very little of it. There is an absolute deficiency of this substance.

The causes of this form should be sought in the following diseases and conditions that affect the brain:

• malignant and benign tumors pituitary gland and hypothalamic region;
• post-infectious syndrome. May occur after severe flu and other viral infections;
• ischemic strokes that disrupt the blood supply to the pituitary gland and hypothalamus;
• development of post-traumatic cysts in the pituitary gland;
• metastatic lesion of the hypothalamic-pituitary system.

Nephrogenic diabetes insipidus - peripheral form

The peripheral form is nephrogenic diabetes insipidus. The word "nephrogenic" means "produced in the kidneys." That is, the brain, hypothalamus and pituitary gland produce a sufficient amount of this hormone, but the kidney tissue does not perceive its orders, and the level of urine output does not decrease from this.

In addition, there is a third form of diabetes, which appears during pregnancy, but, fortunately, often goes away on its own by the end of the third trimester, or after childbirth. Its occurrence is due to the fact that special enzymes secreted by the placenta are capable of destroying hormone molecules, leading to its relative deficiency.

The causes of nephrogenic diabetes insipidus are, of course, kidney damage, as well as some serious illnesses blood:

• congenital and acquired anomalies of the renal medulla;
• glomerulonephritis;
• sickle cell anemia;
• amyloidosis and polycystic kidney disease;
• CRF, or chronic renal failure;
• toxic damage to kidney tissue (with abuse of alcohol substitutes, with prolonged crush syndrome, with the use of medications).

It should be noted that all kidney lesions must be “diffuse” and affect both kidneys. After all, if, for example, a developmental anomaly or post-traumatic contusion affected only one kidney, and the second remained completely healthy, then its functioning is completely “satisfactory” for the body.

It is known that the removal of one kidney (if the second is healthy, its blood flow and urinary drainage are completely preserved) is harmless to the body.

There is also cryptogenic diabetes insipidus. This means that the exact cause has never been discovered, and the frequency of such a diagnosis is quite high - about 30%. This diagnosis is especially often made in elderly patients with multiple endocrine pathology. How does diabetes insipidus occur and what signs are characteristic of it?

Symptoms and signs of diabetes insipidus

diabetes insipidus in women

We said above that the symptoms of diabetes insipidus in women and men are the same. This is so because this hormone is found in the same concentration in representatives of both sexes, and performs the same function in the body. However, the consequences of the disease in women are ovarian disorders - menstrual cycle, amenorrhea, and then infertility. Expressiveness clinical picture depends on two factors:

• Hormone level in the blood;
• The sensitivity of specific receptors to it, which are located in the renal tubules.

If you remember, the same thing characterizes the course of diabetes mellitus: lack of insulin leads to type 1 diabetes, and insulin resistance leads to type 2 diabetes. Actually, this general mechanism for many endocrine diseases.

If everything is disrupted, there are few hormones, and the receptors do not work well, then a pronounced clinical picture of the disease develops. The leading symptoms are round-the-clock, excruciating thirst, and round-the-clock, frequent and profuse urination. The volume of urine produced per day can reach 20-25 liters. Naturally, the body is not able to withstand such a load for a long time.

Therefore, compensatory capabilities are soon exhausted, and patients experience secondary symptoms diabetes insipidus - these include:

• Symptoms of exicosis, or dehydration (dry mouth, dry mucous membranes, sore throat, decreased skin turgor);
• Exhaustion and loss of body weight;
• Gastroptosis (stretching and sinking of the stomach, as the patient drinks almost all day);
  since tissue dehydration and a colossal water load in the intestinal lumen are combined, digestive insufficiency develops,
• The production of bile and pancreatic juice is disrupted, and dysbacteriosis develops;
• Symptoms of ureteral distension and Bladder due to load;
• Sweating is impaired;
• Due to dehydration, rhythm disturbances may occur and blood pressure decreases;
• Due to blood thickening, body temperature decreases, thrombosis is possible, up to the development of heart attacks and strokes;
• Nocturnal enuresis may develop due to simple fatigue of the bladder sphincter;
• The patient experiences constant lethargy, weakness and a pronounced decrease in performance, loss of appetite, nausea and vomiting.

In essence, the patient turns into an exhausted “factory” for pumping water.

Diabetes insipidus in children, features

Diabetes insipidus develops especially severely and quickly in children under one year of age. In addition to the main symptoms described above, the baby becomes dehydrated very quickly and prefers water breast milk, but since he cannot say about his constant thirst, it dies very quickly.

Signs of severe dehydration include dry crying, sunken fontanelles, lack of voice, convulsions and loss of consciousness.

As a rule, the reasons are early form is perinatal or congenital pathology, or developmental abnormalities of the central nervous system.

About the diagnosis of diabetes insipidus

Diagnosis of diabetes insipidus in typical cases is not difficult. Based on complaints and the characteristic clinical picture, the level of the hormone in the blood is determined and kidney function is examined. But most challenging task is not making a diagnosis, but searching for the cause.

For this purpose, MRI and angiography of the brain, pictures of the sella turcica, and extensive hormonal studies are performed. Urography and ultrasound of the kidneys are performed, ions in the blood plasma and urine are determined, and the osmolarity of electrolytes is examined.

There are also quantitative criteria for diagnosing this form of diabetes. These include the following criteria:

• hypernatremia (over 155);
• plasma hyperosmolarity more than 290 mOsm;
• urine hypoosmolarity (decrease) less than 200 mOsm;
• isohyposthenuria, that is low density urine that does not exceed 1010.

All these data may also support a diagnosis of diabetes insipidus. They usually differentiate from diabetes mellitus, as well as from neurogenic (psychogenic) polydipsia. How to treat this severe pathology, and is it possible to achieve full compensation for the condition?

Sometimes eliminating the cause (for example, treating glomerulonephritis) leads to the disappearance of the symptoms of this disease. If the cause is not found, and the amount of urine excreted does not exceed 3–4 liters per day, then the treatment of symptoms of diabetes insipidus in women and men is compensated by a diet and regimen that is not difficult to follow.

Drugs

When severe course illness, absence, or sharp decline level of the hormone in the blood, replacement therapy with desmopressin, an analogue of ADH, is prescribed. The drug is also called “Minirin” and is used in tablet form.

Since the “norm” for hormone production depends on the level of its deficiency, during the first week of administration a dose is selected, which is gradually increased until the state of health is normalized and the symptoms of the disease are eliminated. The drug is taken three times a day.

In the event that central forms ADH is still produced, then treatment of diabetes insipidus is carried out with drugs that increase the secretion of ADH. These include Miscleron and the anticonvulsant drug carbamazepine.

In the renal form is assigned complex treatment. They use NSAIDs, diet, and cytostatics (especially in the treatment of autoimmune kidney inflammation). Reduce the amount of salt in the diet, increase potassium (baked potatoes, dried fruits). In order to reduce thirst, it is useful to refuse sweet foods.

Treatment prognosis

In case of early and timely diagnosis, diabetes insipidus is a typical "disease of control". With cryptogenic forms, the patient is treated for life; in case of absolute deficiency, he takes the drug “Minirin” for life, and from time to time monitors ion exchange indicators.

• In the event that the cause was kidney disease, then this disease with proper treatment can be defeated.