DIABETES INSIPIDUS

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diabetesDiabetes insipidus is a rare chronic disease in which large quantities of dilute urine is produced. It is accompanied  by a desire to drink large amount of water. The urine in this disorder does not contain glucose (sugar) as is the case in diabetes mellitus. The fundamental difficulty is a failure of the posterior lobe of the pituitary to produce the normal amount of the posterior lobe of the pituitary to produce the normal amount of the anti-diuretic hormone ADH ,which acts on the cells of the kidney tubules in such a way as to favor the resorption of water from the kidney tubules.The treatment of this diabetes requires the careful planning and supervision of a highly qualified specialist.

 

EXAMINATIONS AND ANALYZES
The water deprivation test to determine if there are still possibilities for secretion of the hormone ADH. The test is performed in a hospital quickly to compensate for any dehydration. The patient urine, then weighed and he lies in bed. Every 15 minutes, weighed, he takes the tension, and every 30 minutes the urine is collected in jars numbered. The test ends when the patient shows signs of discomfort: anxiety, dry mucous membranes, rapid pulse, low blood pressure and weight.The combination of dehydration and the inability of the kidney to concentrate urine despite the removal of drinks, makes the diagnosis.It goes without saying that in a true diabetes  can not conduct this test to completion.
The test can recognize vasopressin deficiency in DHA.Other tests may be performed, most commonly used tests are the therapeutic use of certain drugs anti-diuretic property.It is possible that the differential diagnosis is difficult potomania even after these events, because a prolonged potomania can inhibit the secretion of the hormone ADH (diabetes induced), because diabetes can heal the sick but who took the habit of drinking a lot will continue, and therefore excessive urination (diabetes self-sustaining), or because there are disturbances primitive thirst center (by injury or a tumor in the hypothalamus). Sometimes the doctor uses a test reconditioning, with appropriate psychotherapy. The goal is to persuade the patient to drink less, with a sodium diet, possibly an anti-diuretic drug is gradually replaced by a placebo.

CAUSES AND RISK FACTORS

diabetes insipidusThe causes of diabetes insipidus are most often acquired  sequel of head trauma, meningitis, encephalitis neurological intervention in the region hypothalamic pituitary brain tumor (craniopharyngioma, metastatic cancers of lung, breast cancer, colon), tuberculosis, sarcoidosis, histiocytosis X, Schuller-Christian disease,: brain injury, removal of the pituitary, hypothalamic cyst or tumor (craniopharyngioma, metastasis), tuberculosis, sarcoidosis, meningitis, encephalitis, etc.. In some cases, no cause is found. There are familial and congenital Nephrogenic .This diabetes  can be congenital or secondary to chronic kidney diseases (pyelonephritis), with general diseases reaching the kidney (myeloma, amyloidosis) or medications such as lithium, used in the treatment of bipolar disorder.The MRI examination is essential to find a cause.

TREATMENT:
Hormone replacement therapy is to give the body a synthetic hormone to replace the natural hormone missing. The treatment takes time deficit if transient diabetes  (in the aftermath of a pituitary surgery or during pregnancy), but in most cases it is given life. A single molecule is available: it is desmopressin or DDAVP (Minirin) which acts on the receiver renal natural antidiuretic hormone. It can be administered in different forms: tablets, nasal solution, nasal spray and injection.For nephrogenic diabetes , hormone replacement therapy has no effect. It will mainly deal with kidney disease or to discontinue the drug causing the deficit urine concentration. In the case of genetic disease, drugs aimed at reducing the severity of symptoms and prevent dehydration.

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