Treatment of diabetes insipidus (DI) abroad
Diabetes insipidus is an endocrine illness accompanied by a sharp increase in fluid intake and daily diuresis (urine volume). DI is rarely met and makes up less than 1% of all pathologies of endocrine glands.
Illness leads to lethal outcome if not treated, as a consequence of dehydration and electrolyte disorders. However, hormone replacement therapy can restore normal water-mineral metabolism.
Causes of diabetes insipidus
DI can be central or renal. Central DI is caused by an antidiuretic hormone (vasopressin) deficiency which is produced by the pituitary gland.
Renal DI is very rare and is peculiar with the normal numbers of anti-diuretic hormone, but renal receptors don’t perceive it.
Causes of renal DI are:
- Genetic predisposition
- Consumption of lithium drugs
- Kidney failure
Causes of central DI are:
- Damaged pituitary gland because of neurosurgical operations (20% of cases)
- Destructive processes in the pituitary gland area (usually metastases of cancer, less often - trauma or inflammatory processes)
- Autoimmune inflammation when the pituitary cells are destroyed by their own antibodies
- Hereditary, though it’s a rare form of the pathology occurring together with Wolfram syndrome
65% of patients have a secondary (symptomatic) DI that occurs on the basis of other different pathologies. 35% of patients have a primary form of DI of an autoimmune origin. Then they diagnose idiopathic diabetes insipidus.
Symptoms of diabetes insipidus
Main symptoms of DI are polyuria and polydipsia. A patient drinks lots of water and frequency of daily diuresis increases substantially.
The onset of the disease.Symptoms of diabetes insipidus mostly occur suddenly, less often they develop gradually. Nocturia is an increase in diuresis at night can be a first sign of DI in children. Some suffer from bedwetting.Females can have the disease during the pregnancy.
Symptoms severity depends on how high an antidiuretic hormone defeiciency is. Polydipsia is the consumption of water ofmore than 3 liters per day.In severe cases (severe deficit of antidiuretic hormone), the patient is racked by unquenchable thirst around the clock.The volume of liquid consumption can be up to 20 liters, and in some patients this number is up to 40 liters daily.
Diuresis increases in proportion to the amount of fluid you drink with urine of low concentration. Urine masses are totally transparent like water. In children, liquid can also come out through the intestine and they often have diarrhea.
Dehydration symptoms. If the volume of fluid that comes out of the body is not replenished, there are symptoms of dehydration. These include:
- Increased heart rate
- Low blood pressure
- Overalll weakness
Dehydration for DI has a peculiar feature is absence of osmolarity increase and urine concentration.
Late symptoms. Long-term diabetes insipidus leads to an expanded bladder and renal ducts as a result of their constant overstretching. Stomach can be enlarged and lowered. There is also a tendency for low blood pressure.
Diagnostics of diabetes insipidus (DI)
Criteria for the diagnosis of diabetes insipidus:
- Polyuria which is diuresis of no less than 3 liters per day
- Normal blood glucose level (excludes diabetes mellitus)
- Low density of urine (below 1005)
- Low osmolarity of urine (below 300 mOsm / kg)
In addition to diabetes mellitus it is necessary to exclude:
- Kidneys pathology
- An elevated level of calcium in the blood
- Low levels of potassium in the blood
Dry diet test helps to confirm the diagnosis, when a person is prohibited to drink water within 12 hours. DI is verified if body weight decreases by 5% and more, and urine osmolarity is still lower than 300 mOsm/kg .
Also MRI is done to evaluate the level of structural changes. This diagnostics technique helps to visualize the sizable formations in the central nervous system.
Treatment of diabetes insipidus abroad
Diabetes insipidus develops as a result of hormone vasopressin deficiency. As follows, it is necessary to replace this pathological condition. A synthetic analogue of the anti-diuretic hormone called desmopressin is used for the disease treatment. It is prescribed in the form of pills or nasal spray. Replacement therapy is prescribed for the rest of the life. Doses are determined based on how severe vasopressin deficiency is.
Diabetes insipidus of renal origin is very hard to treat. Right now, there is only symptomatic and pathogenetic treatment aimed at preserving fluid in the body and reducing electrolyte disturbances.
Such drugs are:
- Thiazide diuretics (hydrochlorothiazide)
- Non-steroidal anti-inflammatory drugs (indomethacin)
- Potassium-sparing diuretics (amiloride)
Renal DI caused by the lithium drugs is treated by thiazide and loop diuretics. Recent research has shown that potassium-sparing diuretics are also effective for this pathological condition cure, therefore, amiloride is also prescribed in German hospitals and other developed countries.
Prognosis for diabetes insipidus
Prognosis depends on the cause that triggered the pituitary gland failure. All patients can be defined into three groups due to this indicator:
- 1.Postoperative diabetes insipidus develops after a pituitary gland injury during a surgical operation. The prognosis is favorable. In most patients, diabetes insipidus is transient. The level of vasopressin secretion is completely or partially restored after some time.
- 2. Primary idiopathic diabetes insipidus. Prognosis for treatment is unfavorable. However, lifelong replacement therapy can compensate this condition. The life expectancy of such patients corresponds to the general population.
- 3. Secondary (symptomatic) diabetes insipidus. The prognosis is determined by the underlying disease. Most often these are tumors of the central nervous system, or metastases of cancer from other parts of the body.
If a pregnant woman has diabetes insipidus during pregnancy, spontaneous disappearance of symptoms and normalization of vasopressin levelis possible after 1-1,5 months after childbirth. However, in the future, the risk of re-occurrence of the disease remains elevated.