Diabetes Insipidus

There is a difference between diabetes false diabetes insipidus and diabetes, diabetes mellitus, although the participation of diseases in the word "sugar" diabetes, and most important distinction between the two cases is that the urine sugar false be more in quantity, and less in focus, despite the participation of diseases in they cause in thirst and frequent urination.

Diabetes insipidus Diabetes Insipidus
And this disease occurs by 1 per 25,000 people, and the rate of occurrence in males is equal to the incidence in females, and the death from the disease are rare in adults, as long as water intake, and complications such as severe drought, and increased sodium blood hypernatremia, and high temperature fever , and congestive heart failure and circulatory cardiovascular collapse, and as a result of that death may occur in children and elderly or who suffer from complications satisfactory.


Types of diabetes insipidus
There are four types of sugar which is false:

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Type neurogenic neurogenic diabetes insipidus, and arises from the lack or absence of hormone antidiuretic (antidiuretic hormone (ADH, which results from a flaw or defect in the position of one or more of the brain. These include placements: receptors pantheism osmoreceptors of the hypothalamus hypothalamic, or nuclei nuclei supraoptic supraoptic, or on both sides of the ventricles paraventricular, or the area above the optic nerve and under the pituitary gland supraopticohypophyseal tract. In contrast, injuries lobi posterior posterior pituitary of the pituitary gland rarely cause sugar false lasting, because the hormone is stored only lobe back, and is produced and secreted by the hypothalamus hypothalamus, therefore, continue without interruption excreted circulation in these cases.
Type neurogenic

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Sugar false arising from the kidney Nephrogenic diabetes insipidus: and caused by an inability to concentrate urine, due to the resistance of kidney hormone antidiuretic, and this kind of possible existence in chronic renal failure chronic renal insufficiency, and toxicity of lithium, and increase the level of calcium in blood, and the low level of potassium blood, and diseases of the urinary tubes tubulointerstitial disease, and there are rare cases - arising from the faulty hormone receptor anti-secretion of urine - because of a hereditary kidney disease.
Sugar false arising from the kidney


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Type arises from the intensity of thirst and drinking water or other liquids heavily dipsogenic diabetes insipidus.
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Type occurs only during pregnancy gestagenic diabetes insipidus.

Causes of diabetes insipidus
Reports indicate that 30% of cases are idiopathic, and 25% of which has a link to the pituitary gland tumors, both benign or malignant, and 16% due to bruising of the head, and 20% after the surgery to be the head following cranial surgery.

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Some cases is not known why Idiopathic diabetes insipidus, and these cases are often accompanied by the crash of the cells of the hypothalamus hypothalamus, and is likely to be part of the autoimmune reaction autoimmune process, and distinguish these cases the presence of white blood cells of the type Allimvi, Basuep pituitary pituitary stalk, and the lobe posterior posterior pituitary. It was found MRI MRI changes are, as shown by the presence of antibodies to the cells to secrete the hormone antidiuretic when the majority of these cases, and should follow up on cases of unknown cause, as some small tumors that grow slowly found its presence after nearly 10 years to be the reason behind the appearance of some cases.
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Sugar false domestic Familial diabetes insipidus is rare and is caused by a hereditary dominant autosomal dominant disorder.
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Some cases arise after brain surgery and bruising of the head, and these cases constitute 10-20% of patients who undergo this surgery, and these cases occur mostly when you remove a small tumor pituitary gland, and the incidence may reach to 60-80% when you remove the tumors large, and do not last all these cases, or be chronic, you may be increasing the amount of urine is an excess secretion of fluids given during surgery or as a result give a diuretic during the treatment of brain infiltration of cerebral edema.
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Some cases may be associated tumors such as lung cancer, and lymphatic glands, lymphoma, and cancer of white blood cells of leukemia, and sarcoidosis Allhmanip disease and anorexia nervosa anorexia nervosa, and disadvantages of blood vessels such as the expansion of local arterial aneurysms.

Generate diabetes insipidus
Generate diabetes insipidus
Hormone, anti-urinary excretion, is a decision essential to the secretion of water body, which works mainly on the kidneys, where the change of the penetration of water water permeability through the pipes urinary collected urine, both in layer crust, or layer of bone kidney, and water re-absorption of the impact of this hormone in the urinary tubes, due to blood circulation, and this is done through the influence of hormone receptors in the urinary tubules.


Symptoms of diabetes insipidus
Symptoms depend on the cause of disease, intensity and associated morbidity.

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Most cases of diabetes are common false which are due to bruising. Or surgery, the hypothalamus region of hypothalamus, pituitary gland and pituitary, it is possible that the symptoms are on one of three patterns: the pattern of transit, and continuing pattern or permanent, and offer three stages. And three-phase pattern is the most frequent clinical terms. And stages are:
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Occur at the beginning stage of the large number of urine polyuric phase, which lasts from 4 to 5 days and occur due to curb anti-hormone secretion of urine Inhibition of ADH, causing an immediate increase in urine volume and an accompanying drop in Ozmolip pantheism or urine urine osmolality.
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Followed by a phase of peeing against the antidiuretic phase, which lasts from 5 to 6 days, which occur as a result of starting hormone inventory and a concomitant increase in urine Ozmolip or pantheism.
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And the third stage of the disease can be permanent and sugar false when stores deplete anti-hormone secretion of urine and the cells to secrete the hormone is absent or unable to discharge.

And are frequent urination Polyuria, thirst and frequent polydipsia, and urination during the night (from 3 to 18 liters) are the prevailing symptoms.


When babies have to cry and scream, and tension irritability, and growth retardation, and increased body temperature, and weight loss are the most apparent signs.


And when children have bed wetting, loss of appetite and growth defects, and exhaustion and fatigue, are the most prevalent signs and symptoms.


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The patients whose cases are not due to bruising course of the disease shall be inert indolent course, and the pregnancy is accompanied by an increased risk of the disease and the most important symptoms they have are:
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Frequent urination, and frequent thirst, swelling of the kidneys and hydronephrosis, and the magnitude of the bladder and the signs of dehydration are common.
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Symptoms, and signs of impaired function of anterior pituitary gland, simultaneous, may be present but are rare.
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The volume of urine daily by the wide variation (from 2 to 20 liters), as well as the varying ability of people to drought tolerance.
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Many patients have a tendency to drink cold liquids, and often with cold water.

Signs of diabetes insipidus
The signs vary depending on the severity of cases, and depending on the duration of the disease, the signs are not satisfactory, and there may be signs of dehydration, may increase the size of the urinary bladder.


Diagnosis of diabetes insipidus

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The diagnosis by symptoms, signs, and laboratory tests to confirm the diagnosis, and conducted laboratory tests after the banning of the patient as he could from the water, so as to be hormone antidiuretic in the maximum rates, as well as the concentration of urine, and should exclude diabetes diabetes mellitus.
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Must be measured in salts and minerals in blood serum electrolytes, and the sugar glucose, and specific gravity of urine, and sodium urine, and pressure Arashhi of Paul urine osmolality, and pressure Arashhi of the liquid blood serum osmolality, and the level of hormone antidiuretic, and stresses the test results of diagnosis, when the specific gravity of urine 1.005, or less, and be pressed to Paul Arashhi less pressure Arashhi random plasma.
Pressure Arashhi of Paul urine osmolality
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Water deprivation test Miller-Moses test
Water deprivation test curve
Is being done in chronic cases, and have deprived the patient from the water to feel thirsty, or low blood pressure, or the emergence of signs of dehydration, and in simple cases of frequent urination, deprivation of water the night before, while in cases of extreme deprivation during the day, so that we can observe the patient, and in this test, the body weight every hour, as well as pressure Arashhi of Paul, and when the difference between the Znin consecutive decrease of more than 3%, or differential pressure Arashhi decrease of 30 units, is given hormone antidiuretic under the skin, then taken a urine sample after 60 minutes to measure the pressure Arashhi, and in normal individuals have pressure Arashhi of Paul from 2 to 4 times the pressure Arashhi of the liquid blood, and the increase in pressure Arashhi of Paul after the injection of the hormone 9%, and the time required to reach the maximum concentration of urine from 4 to 18 hours, and in cases arising from the false sugar shortage or lack of secretion of the hormone, the test confirms the diagnosis when no increase in urine concentration despite the increase in blood concentration of the liquid, and after the injection of the hormone to increase the pressure of Paul Arashhi exceed more than 50%. The people who are sick sugar false arising from the kidney, the level of hormone antidiuretic be in the normal level or increase from normal blood, the kidneys do not respond after the injection of the hormone during the test.
Lack of water and increasing salt

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Used MRI on the brain and pituitary gland
MRI on the brain and pituitary gland

Treatment of diabetes insipidus

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Patients should avoid dehydration treatment of diarrhea and vomiting at the occurrence, and away from stress and hot weather.
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The patient should drink enough fluids to replace the amount lost in urine, and must avoid an increase in blood sugar, and avoid an increase in blood volume, and correct the increase of sodium in blood.
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Possible that the patient needs medication called desmopressin, desmopressin, which can be taken once or twice a day.
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Admission to hospital to take fluids, and to measure frequent blood salts and minerals.
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Includes the treatment of sugar resulting from a lack of false hormone products - similar to the hormone antidiuretic - in the form of subcutaneous injections or medicines taken through the nose or mouth.
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Includes diabetes resulting from false kidney Alklorbrupamid drugs such as chlorpropamide, which increases sensitivity and response of the kidney hormone, antidiuretic, and ibuprofen Ibuprofen, which reduces the urine volume and increases the pressure Arashhi of Paul, as well as Aliindaumithasin indomethacin.