Diabetes insipidus

Diabetes is insipid - a disease caused by absolute or relative deficiency of antidiuretic hormone (vasopressin) and characterized by polyuria and polydipsia.

Etiology. Acute and chronic infections, tumors, traumas (casual, surgical). Vascular lesions of the hypothalamic-pituitary system are known. In some patients, the etiology of the disease remains unknown - this form is identified as idiopathic diabetes insipidus.

Pathogenesis. Violation of the secretion of antidiuretic hormone (the central form of the disease) or the lack of physiological action of the antidiuretic hormone with its normal secretion (relative insufficiency). In the development of the latter, the inferiority of the regulation of water-salt metabolism, the decrease in the ability of the tubular epithelium of the kidneys to react to the antidiuretic hormone (the pathogenic form of the disease) in cystic, degenerative and inflammatory lesions of the kidneys, and the increased inactivation of the antidiuretic hormone by the liver and kidneys. The lack of antidiuretic hormone leads to a decrease in the reabsorption of water in the distal sections of the renal tubules and collecting tubes of the kidneys and contributes to the release of a large amount of unconsolidated urine, general dehydration, thirst and a large amount of fluid.

Symptoms, course. The disease occurs in people of both sexes at a young age. Suddenly, there are frequent and profuse urination (polyuria), thirst (polydipsia), which disturb the sick at night, disturbing sleep. The daily amount of urine is 6-15 liters or more, the urine is light, of low relative density. There is a lack of appetite, weight loss, irritability, fatigue, dry skin, decreased sweating, impaired function of the gastrointestinal tract.

Perhaps the lag of children in physical and sexual development. Women may experience a menstrual cycle, in men - a decrease in potency. Characteristic of mental disorders: insomnia, emotional imbalance. With the restriction of consumed fluid, the patients develop symptoms of dehydration: headache, dry skin and mucous membranes, nausea, vomiting, fever, tachycardia, mental disorders, thickening of blood, collapse.

The diagnosis is based on the presence of polydipsia, polyuria with a low relative density of urine and no pathological changes in the urinary sediment; The absence of an increase in the relative density of urine in a sample with dryness: high plasma osmolarity, a positive sample with the introduction of pituitrin and a low content of central antidiuretic hormone in the blood plasma.

The prognosis for life is favorable, however, cases of recovery are rare.

Treatment is aimed primarily at eliminating the underlying cause of the disease (neuroinfection, tumors). Carry out replacement therapy with adiurecrin, adiuretin, pituitrin. Chlorpropamide (under the control of blood glucose level), clofibrate (Miscleron), tegretol (finlepsin, carbamazepine), hypothiazide are also used. General strengthening therapy.