Diabetes insipidus – what is it, signssymptoms in women and men, treatment, prognosis

Diabetes insipidus is a rare endocrine disease,
resulting from relative or absolute insufficiency
vasopressin (a non-irogypophysial hormone) and manifested
exhausting urination (polyuria) and intense thirst
(polydipsia).

For more information about what this disease is, what
causes, symptoms in men and women, and what is prescribed in
As a treatment for adults, we consider further.

What is diabetes insipidus?

Несахарный диабет

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

The disease may begin suddenly or develop.
gradually. Primary signs of diabetes insipidus –
increased thirst and frequent urination.

Despite the fact that there are two similar in name species
заболеваний —  сахарный и несахарный диабет, это две
completely different diseases, but the symptoms overlap. Their
combine only some similar symptoms, but diseases
caused by completely different disorders in the body.

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

Hypothalamus – the brain region responsible for regulation
the entire endocrine system of the body produces antidiuretic
hormone (ADH), also called vasopressin.

In diabetes mellitus, everything that was filtered is derived from
organism. Liters and even dozens of liters per day are obtained.
Naturally, this process forms a strong thirst. Sick
a person is forced to drink plenty of fluids in order to somehow make up
its deficiency in the body.

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

In children, diabetes insipidus is usually congenital, although
его диагностика может произойти довольно поздно — после 20 years old. Have
adults are more often diagnosed with an acquired form of the disease.

Classification

Современная эндокринология классифицирует несахарный
diabetes depending on the level at which the disturbances occur.
There is a central (neurogenic, hypothalamic-pituitary) and
renal (nephrogenic) form.

Neurogenic diabetes insipidus

Neurogenic diabetes insipidus (центральный). Develops in
result of pathological changes in the nervous system, in particular
in the hypothalamus or posterior lobe of the pituitary gland. Usually,
the cause of the disease in this case are operations on
complete or partial removal of the pituitary gland, infiltrative pathology
this area (hemochromatosis, sarcoidosis), injury or changes
inflammatory nature.

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

  • idiopathic – a hereditary type of disease that
    characterized by a decrease in the synthesis of ADH;
  • symptomatic – develops against the background of other pathologies. Can
    to be as acquired (develops throughout life), for example,
    due to TBI, tumor development. Or congenital (with mutations
    genes).

With a long-term central diabetes insipidus in a patient
renal insensitivity to artificially administered
antidiuretic hormone. Therefore, the sooner treatment will begin
diabetes mellitus of this form, the more favorable the prognosis.

Renal diabetes insipidus

What it is? Renal or nephrogenic ND – associated with reduced
sensitivity of kidney tissue to the effects of vasopressin. This kind
The disease is much less common. The cause of the pathology becomes
either structural impairment of nephrons or resistance
renal receptors for vasopressin. Kidney diabetes can be
congenital, and may occur as a result of renal damage
cells under the influence of drugs.

Sometimes there is also a third type of diabetes insipidus, which affects
women during pregnancy. This is quite rare. It
arises due to the destruction of hormones by enzymes formed
placenta. After the birth of the baby, this type passes.

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

The reasons

Diabetes insipidus develops when deficiency occurs
antidiuretic hormone (ADH) vasopressin – relative or
absolute. ADH produces the hypothalamus and it performs various
functions, including affecting the normal operation of the system
urination

Hereditary disease non-sugar diabetes is not but
some autosomal recessive inherited syndromes (for example,
Tungsten disease, complete or incomplete diabetes insipidus)
constitute a part of the clinic indicating genetic
mutation.

The factors predisposing to the development of this pathology,
are:

  • infectious diseases, especially viral;
  • brain tumors (meningioma, craniopharyngioma);
  • metastases in the hypothalamus cancer after extracranial localization
    (usually bronchogenic – originating from the tissues of the bronchi, and
    breast cancer);
  • cranial injuries;
  • concussion;
  • genetic predisposition.

When idiopathic form of non-sugar diabetes in the body
the patient, for no apparent reason, begins to produce antibodies,
that destroy cells that produce antidiuretic
hormone.

Renal diabetes insipidus (почечная форма) возникает в
the result of intoxication of the body with chemicals, violations
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 both men and women, in
любом возрасте, чаще всего в возрасте 20-40 years old. Expressiveness
The symptoms of this disease depend on the degree of vasopressin deficiency.
With a slight lack of hormone clinical symptoms
can be erased, not pronounced. Sometimes the first symptoms
diabetes mellitus appear in people who have been in conditions
питьевого дефицита  — в путешествиях, походах, экспедициях, а
also when taking corticosteroids.

To the main symptoms that manifest with 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;
  • dry skin, nausea and vomiting, seizures;
  • mental disorders (insomnia, emotional lability,
    decrease in mental activity).

Even if the patient is restricted in the use of fluid urine
will still stand out in large numbers, which will lead to
общему обезвоживанию organism.

Besides the general signs, there are a number of individual symptoms,
that occur in patients of different gender and age:

Symptoms and signs
Diabetes insipidus in women  Men suffer from diabetes mellitus as often as
women. Most new cases of pathology occur in young people.
people. The disease usually debuts in patients as young as 10
до 30 years old.Основные симптомы, указывающие на нарушение секреции
vasopressin and the development of diabetes insipidus:

  • Urinary incontinence;
  • Intense thirst;
  • Decreased libido;
  • Emotional instability;
  • Headaches;
  • Trouble falling asleep and sleep depth;
  • Weight loss;
  • Dry, flaky skin;
  • Decreased kidney function;
  • Dehydration.
Diabetes insipidus in men The development of this disease begins suddenly, accompanied by
such phenomena as polydipsia and polyuria – a strong feeling
thirst, as well as an increase in the frequency and volume of urination. More
развернутые клинические признаки у женщин могут включать в
yourself:

  • poor appetite
  • weight loss;
  • loss of appetite or its absolute absence;
  • pain in the stomach, feeling of heaviness and
    nausea;
  • imbalance of stool, intestinal irritation, feeling of bloating
    abdominal pain, cramping or dull pain in the right
    hypochondria;
  • heartburn, belching and vomiting;
  • disturbances of the natural menstrual cycle, in some
    cases – spontaneous miscarriages and the development of infertility.

The presence of non-diabetes mellitus is indicated by the following
signs:

  • urine density below 1005;
  • low concentration in the bloodstream vasopressin;
  • decrease in the level of potassium in the blood;
  • increased levels of sodium and calcium in the blood;
  • increase in daily diuresis.

Consultation required when detecting renal diabetes
urologist When involved in the process of genitals and violation
flow of the menstrual cycle consultation is necessary
gynecologist.

Have детей Differences in symptoms of diabetes insipidus in adult patients and
adolescents minor. In the latter case
perhaps a brighter manifestation of pathology:

  • decreased appetite;
  • slight weight gain or lack thereof;
  • increased vomiting during meals;
  • difficult defecation;
  • nocturnal enuresis;
  • soreness in the joints.

Complications

The risk of diabetes insipidus is the risk of developing
dehydration of the body what happens in those situations in which
loss of urine fluid from the body is not appropriately
replenished. For обезвоживания характерными проявлениями
are:

  • general weakness and tachycardia
  • vomiting
  • mental scale disorders.

Blood clots, neurological disorders and
hypotension, which can reach a state of collapse.
It is noteworthy that even severe dehydration is accompanied
preservation of polyuria.

Diagnostics

A doctor who deals with such pathologies is an endocrinologist.
If you experience most of the symptoms of this disease, then first
it is worth going to endocrinologist.

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

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

  • extreme thirst
  • daily urine volume of more than 3 liters per day
  • plasma hyperosmolality (more than 290 mosm / kg, depends on
    fluid intake)
  • high sodium
  • urine hypoosmolality (100–200 mosm / kg)
  • низкой относительной плотности мочи (<1010).

Laboratory diagnosis of diabetes insipidus includes
following:

  • Zimnitsky test – an exact daily count
    drunk and excreted fluid;
  • ultrasound examination of the kidneys;
  • X-ray examination of the skull;
  • computed tomography of the brain;
  • echoencephalography;
  • excretory urography;
  • extensive biochemical blood test: quantification
    sodium ions, potassium, creatinine, urea, glucose.

The diagnosis of diabetes insipidus is confirmed on the basis of
laboratory data:

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

Treatment

After confirming the diagnosis and determining the type of non-sugar
diabetes prescribed therapy aimed at eliminating the cause,
caused it – removal of tumors, treatment of the main
diseases, elimination of brain injury.

For компенсации необходимого количества антидиуретического
hormone for all types of diseases prescribed desmopressin
(synthetic analogue of the hormone). It is applied by instillation into
nasal cavity.

Now widely used to compensate for the central
diabetes mellitus received drugs Desmopressina. is he
produced in 2 forms: drops for intranasal administration –
Adiuretin and Minirin tablet form.

Clinical guidelines also include the use of
products such as Carbamazepine and Chlorpropamid to stimulate
hormone production by the body. Since abundant urine
leads to dehydration, to restore
water-salt balance salt solution is administered to the patient.

In the treatment of diabetes insipidus can also be prescribed
drugs that affect the nervous system (for example, “Valerian”,
�”Bromine”). Nephrogenic diabetes provides for the appointment
anti-inflammatory drugs and thiazide diuretics.

An important component of the treatment of diabetes insipidus is
correction of water-salt balance using infusion
the introduction of a large amount of salt solutions. For эффективного
reduce urine output recommend taking sulfa
diuretics.

Thus, diabetes insipidus is the result of a deficiency
antidiuretic hormone in humans for various
reasons. However, modern medicine can compensate for this.
lack of substitution therapy with a synthetic analogue
hormone.

Competent therapy returns a sick person to the mainstream
full life. This is not a complete recovery.
literally, however, in this case the state
health as close to normal.

Nutrition and diet for diabetes insipidus

The main goal of diet therapy is to reduce urination, and
in addition, replenishing the body with vitamins and minerals,
которые они «теряют» в связи с частыми позывами в туаyears old.

It is preferable to prepare just such
ways:

  • boil;
  • for a couple;
  • simmer the food in a skillet with olive oil and water;
  • bake in the oven, preferably in the sleeve, for safety
    all nutrients;
  • in the slow cooker, except the “fry” mode.

When у человека несахарный диабет диета должна исключать те
categories of foods that increase thirst, such as sweets,
fried foods, spices and seasonings, alcohol.

The diet is based on the following principles:

  • reduce the amount of protein consumed, leaving the carbohydrate rate
    and fat;
  • reduce the salt concentration, 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 in the diet of fish and seafood, egg yolks;
  • take fish oil and phosphorus;
  • eat often in small portions.

Sample menu for the day:

  • the first breakfast is an omelet (steamed) of 1.5 eggs, vinaigrette (with
    vegetable oil), tea with lemon;
  • second breakfast – baked apples, jelly;
  • обед – суп из овощей, мясо отварное, свекла тушеная,
    lemon drink;
  • afternoon tea – dogrose broth, jam;
  • dinner – boiled fish, boiled potatoes, sour cream, tea with
    a lemon.

Drinking plenty of water is necessary – because the body loses a lot of water while
dehydration and it needs to be compensated.

Folk remedies

Before using folk remedies for diabetes insipidus,
Be sure to consult with the endocrinologist, because are possible
contraindications.

  1. Twenty grams of dried elderberry blossoms poured into a glass
    highly hot water, and the resulting decoction is infused over
    one hour. The resulting composition is mixed with a spoon of honey and
    consumed three times daily.
  2. To largely eliminate thirst and reduce
    urine excretion, must be treated with burdock infusion. For
    cooking means will need 60 grams of the root of this plant,
    which need to grind as much as possible, fall asleep in a liter
    thermos and pour boiling water to full volume. Insist root
    burdock need until the morning, after which the remedy is taken 3 times a day
    half a glass
  3. Infusion of motherwort from diabetes insipidus. Ingredients:
    motherwort (1 part), valerian root (1 part), hop cones (1
    часть), плоды шиповника и мята (1 часть), кипяток (250
    ml.). All herbal ingredients are mixed and thoroughly
    crushed. Take 1 spoonful of the mixture and pour boiling water. Insist
    hour. Accepted in the amount of 70 – 80 ml. before
    a dream. Польза: настой успокаивает организм, снимает
    irritability, improves sleep.
  4. To reduce thirst and restore balance in the body, you can
    use infused walnut leaves. Going young
    the leaves of this plant are dried and crushed. After this tea
    spoonful of dry matter brewed glass (250 milliliters)
    boiling water. After fifteen minutes, the resulting broth can be
    eat like regular tea.
  5. To overcome the disease will help and the collection of various herbs: fennel
    motherwort, valerian, fennel, cumin seeds. All the ingredients you need
    take in equal quantities, mix well. After this dining
    a spoonful of dry mix is ​​poured with a glass of boiling water and infused until
    complete cooling of the liquid. It is necessary to accept means on
    половине стакана before a dream.

Forecast

Diabetes insipidus developing in the postoperative period or
при беременности, чаще носит транзиторный (преходящий)
character, idiopathic – on the contrary, persistent. With appropriate
there is no danger to life, although recovery is fixed
seldom.

Recovery of patients occurs in cases of successful removal.
tumors, specific treatment of diabetes insipidus
tubercular, malarial, syphilitic genesis. With the right
appointment of hormone replacement therapy is often preserved
working capacity.

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