Non-diabetes mellitus: symptoms in women, treatment

Non-diabetes is a disease that occurs as a result of an insufficiency of the antidiuretic hormone (vasopressin) or an impaired sensitivity to the kidney tissue. The main symptoms of the disease are excessive discharge of urine (which is why this condition is called "diabetes", and the word "non-sugar" indicates a lack of problems with the blood sugar in this disease) and a strong thirst. Non-diabetes mellitus can be a congenital or acquired disease, it affects both men and women. There are quite a few causes of diabetes insipidus. Treatment of the disease consists in 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 by special fibers enters the pituitary gland and accumulates there. Hypothalamus and pituitary gland are part of the brain. From the pituitary gland the hormone is thrown into the bloodstream, with the blood flow to the kidneys. Normally, the antidiuretic hormone ensures that the fluid in the kidneys is absorbed back into the bloodstream. That is, not everything that filtered through the kidney barrier is excreted and is urine. Most of the liquid is reabsorbed back. With diabetes insipidus all that filtered out is excreted from the body. Liters are obtained and even dozens of liters per day. Naturally, this process forms a strong thirst. A sick person is forced to drink a lot of fluids to somehow make up for her deficiency in the body. Infinite urination and the constant need for fluids exhaust a person, so the synonym of diabetes insipidus is the term "diabetes".

Non-diabetes refers to a fairly rare disease: its incidence is 2-3 cases per 100 000 population. According to statistics, the disease is equally often affects the female and male sex. Diabetes mellitus can be affected at any age. You can be born with him, you can get him in old age, but nevertheless the peak of the incidence falls on the second-third decade of life. The disease is multifactorial, that is, it has many causes. Let us dwell on this point in more detail.

Causes of diabetes insipidus

All cases of diabetes insipidus are divided into central and renal. This classification is based on the causes of the occurrence.

Central diabetes insipidus is associated with problems in the hypothalamus and pituitary gland in the brain (that is, as if "in the center"), where it forms and accumulates antidiuretic hormone; The renal is due to the immunity of the excretory organs to the perfectly normal hormone vasopressin.

Central diabetes insipidus arises as a result of the formation of an insufficient amount of antidiuretic hormone, a violation of its release, its blockade with antibodies. Such situations can arise when:

• genetic disorders (defects of genes responsible for the synthesis of vasopressin, skull defects in the form, for example, microcephaly, underdevelopment of individual brain regions);
• neurosurgical operations (the intervention can be carried out for any reason: traumatic brain injury, tumors and other causes). There is an anatomical damage to the structures of the hypothalamus or fibers coming from it to the pituitary gland. According to statistics, every fifth case of diabetes insipidus is the result of neurosurgical intervention. However, there are cases of transitory (transient) diabetes insipidus after cerebral operations, in such cases the disease goes away at the end of the postoperative period;
• brain irradiation for tumor diseases (the tissue of the hypothalamus and pituitary gland is very sensitive to X-rays);
• craniocerebral trauma (destruction of the hypothalamus, pituitary gland, edema or compression of these areas);
• tumors of the hypothalamic-pituitary region and the region of the Turkish saddle;
• Neuroinfections (encephalitis, meningitis);
• vascular lesions of the hypothalamic-pituitary region (stroke, 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 blocking the hormone itself, turning it into an inoperative state). This situation is possible with sarcoidosis, tuberculosis, granulomatous lung diseases;
• application of Clonidine (Clopheline);
• for no apparent reason. In such situations, talk about idiopathic diabetes insipidus. It accounts for about 10% of all cases of central diabetes insipidus and develops in childhood.

Sometimes insipid diabetes appears during pregnancy, but after it is completed, the symptoms can go away.

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

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

Symptoms

In most cases, diabetes insipidus develops sharply. The main manifestations of the disease are the allocation of a large amount of urine (more than 3 liters per day) and a strong thirst. In this case, an excessive amount of 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 peculiarities:

• low relative density (specific gravity) - less than 1005 (always, in any portion of urine, regardless of the amount of liquid drunk);
• It does not have color, does not contain enough salts (in comparison with normal urine);
• It is free of pathological impurities (for example, increased white blood cell count, red blood cell presence).

A characteristic feature of diabetes insipidus is the excretion of urine during any time of the day, including at night. Constant urge to urinate does not make it possible to fall asleep, exhausting the patient. Sooner or later this situation leads to nervous exhaustion of the body. Neurosis and depression develop.

Even if a person is not allowed to drink, urine will still form a lot, leading to dehydration of the body. This phenomenon is based on a diagnostic test confirming the presence of diabetes insipidus in a patient. This is the so-called dry-drying test. Within 8-12 hours the patient is not given any liquid (including food). In the case of existing diabetes insipidus, urine continues to be released in large amounts, the density it does not increase, osmolality remains low, and the weight is lost more than 5% of the original.

The intake of excess urine results in the expansion of the renal and pelvic system, ureters and even the bladder. Of course, this does not happen immediately, but with a certain period of illness.

The thirst for diabetes insipidus is a consequence of the loss of a huge amount of fluid in the urine. The body is trying to find ways to restore the contents of the bloodstream, and therefore thirst arises. I want to drink almost constantly. A person consumes water in liters. Because of this kind of water overload, the gastrointestinal tract stretches the stomach, irritates the intestines, there are problems with digestion, constipation. The first time with diabetes insipid diabetes, the fluid that comes with the drink compensates for losses in the urine, and the cardiovascular system does not suffer. However, over time, a fluid deficit does occur, blood flow becomes insufficient, blood condenses. Then there are symptoms of dehydration. There is a pronounced general weakness, dizziness, headache, heart rate increases, blood pressure drops, it is possible the development of collapse.

Signs of chronic lack of fluid in the body with long-term diabetes insipidus are dry and flabby skin, almost complete absence of sweat, a small amount of saliva. Weight is invariably lost. Disturbing nausea and periodic vomiting.

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

Treatment

The main principle of treatment of diabetes insipidus is substitution therapy, that is, the replacement of the hormone deficiency of 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, drops in the nose) and oral (tablets) use. Most commonly used spray, drops in the nose and pills. Injectable forms are required only in severe cases or, for example, in the treatment of mentally ill people.

The use of a dosage form in the form of a spray or drops in the nose makes it possible to dispense with considerably smaller dosages of the preparation. So, for the treatment of adults, one drop or one injection in the nose (5-10 μg) is prescribed 1-2 times a day, and when used tablets dose is 0.1 mg for 30-40 minutes before meals or 2 hours after meals 2-3 times a day. On average, it is commonly believed that 10 μg of intranasal form is equivalent to 0.2 mg tableted.

Another nuance of the use of drops or spray in the nose is a faster action. With colds or allergic diseases, when the nasal mucosa swells, and it is impossible to adequately absorb the drug, Spray or drops can be applied to the mucous membrane of the oral cavity (the dose is increased by a factor of 2).

The dose of the drug depends on how much of the antidiuretic hormone is produced in the patient, and how much is its deficit. If the lack of a hormone is, for example, 75% - this is a single dose, if 100% (complete absence of a hormone) - the other. Selection of therapy is carried out individually.

Partially increase the synthesis and secretion of its own antidiuretic hormone with carbamazepine (600 mg per day), Chlorpropamide (250-500 mg per day), Clofibrate (75 mg per day). Daily doses of drugs are divided into several receptions. The use of these drugs is justified for partial diabetes insipidus.

Adequate substitution therapy for diabetes insipidus Desmopressin allows a person to lead a normal lifestyle with few restrictions (this applies to eating and drinking). In this case, full retention of work capacity is possible.

Renal forms of diabetes insipidus do not have developed and proven treatment regimens. Attempts are being made to use Hypothiazide in high doses, non-steroidal anti-inflammatory drugs, but not always this treatment gives a positive result.

In diabetes insipidus, patients should adhere to a certain diet. It is necessary to limit the use of proteins (to reduce the burden on the kidneys), to increase the content of foods rich in fats and carbohydrates in the diet. The diet regime is set fractional: eat better often and in smaller portions to ensure the assimilation of food.

It should be noted separately the water load. Without adequate replenishment of fluid loss, diabetes insipidus causes complications. But replenish the loss of liquid with ordinary water is not recommended. 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 with the help of intravenous infusions of saline solutions.

Thus, diabetes insipidus is the result of an antidiuretic hormone deficiency in the human body for various reasons. However, modern medicine can compensate for this deficiency with the help of replacement therapy with a synthetic analogue of the hormone. Literate therapy brings the sick person back to the full life. This can not be called a complete recovery in the literal sense of the word, nevertheless, in this case, the state of health approaches the norm as much as possible. And this is not enough.

The first channel, the program "Health" with Elena Malysheva on "Non-diabetes mellitus: symptoms, diagnosis, treatment": "

Non-diabetes mellitus: symptoms, treatment and diagnosis

Watch this video on YouTube