Diabetes mellitus is called endocrine pathology, which occurs against the background of a sharp decline in the production of vasopressin or a violation of its action. In the first case, the central form of the disease develops, in the second, the renal (nephrogenic) type of pathology, in which the amount of the hormone is sufficient, but due to some changes in the body, the receptors lose sensitivity to it.
The disease can affect both adults and children. Diabetes insipidus in children has a number of similarities and differences from the manifestations of adult pathology. More on this in the article.
Antidiuretic hormone is produced in certain nuclei of the hypothalamus, where it binds with specific transport protein substances and enters the neurohypophysis area. Here vasopressin is until the body needs its action.
The release of the hormone into the blood is regulated by the following indicators:
- osmotic pressure of blood and urine (the lower the indicators, the higher the level of the hormone in the bloodstream);
- circulating blood volume;
- blood pressure indicators;
- wakefulness and sleep (at night the level of the hormone-active substance increases, and the amount of urine produced decreases);
- the action of the renin-angiotensin-aldosterone system;
- pain, a surge of emotion, physical activity - they increase the production of vasopressin;
- nausea and critical decrease in blood sugar - provoke the release of large amounts of hormone in the blood.
Pathology of the hypothalamus and pituitary - one of the causes of the disease
Vasopressin is needed by the body in order to retain a sufficient amount of water by re-sucking it in the formation of urine. The action of the hormone-active substance is carried out by special sensitive receptors, which are localized on the surface of the cells of the collecting tubules and the loop of Henle.
The water level in the body is supported not only by the action of vasopressin, but also by the "center of thirst", which is localized in the hypothalamus. When a significant amount of fluid is excreted from the body and the osmotic concentration of the blood rises, this sensitive center is excited. The person urinates much, accordingly, he has a desire to drink.
The main causes of the disease
Most cases of the development of diabetes insipidus in children have an idiopathic nature. The development of symptoms is possible at any age, but more often it occurs in the preschool period. The idiopathic type of the disease is characterized by dysfunction of the hypothalamic-pituitary region, where the cells responsible for the production of the antidiuretic hormone vasopressin are located.
It is believed that this area may have congenital anomalies that activate the occurrence of the disease under the influence of adverse external and internal factors.
Diabetes insipidus in children can develop on the background of post-traumatic syndrome. It occurs as a result of damage to the base of the skull, the development of cerebral edema due to mechanical damage. Another possible reason is the conduct of neurosurgical operations and manipulations.
There are cases of the development of the disease in 30-45 days from the moment of traumatic brain injury. Such polyuria (excessive amount of urine, which is the leading symptom of diabetes insipidus) is called permanent.
The disease in children can occur as a result of a number of infections:
- whooping cough;
The development of an infectious process - a possible provoking factor for the disease
Important! The process may also involve less dangerous, at first glance, infections of a chronic nature - inflammation of the tonsils, nasopharyngeal diseases.
Diabetes insipidus occurs on the background of neuroinfections due to the abundant blood supply to the hypothalamus and pituitary in children, high vascular permeability, and features of the blood-brain barrier permeability.
Other conditions against which the development of the central type of the disease is possible:
- intrauterine infections;
- emotional stress;
- hormonal changes;
- tumors of the hypothalamus and pituitary;
- the period of treatment of the tumor process;
Causes of renal form
Nephrogenic type of pathology in children arises from the fact that the kidneys can not adequately respond to the action of antidiuretic hormone. This condition can be congenital and acquired. It is characterized by a smaller amount of urination than with a central lesion.
It can develop as a result of congenital anomalies of the anatomy of the kidneys and their structures, against the background of hydronephrosis, polycystic disease, chronic blockage of the urinary ducts, chronic pyelonephritis.
Manifestations of the disease
Symptoms of diabetes insipidus in children can occur abruptly or gradually. If post-traumatic syndromes accompanied by the development of the disease manifest themselves in a few months, then the echoes of neuroinfection - in a few years.
Polyuria - the main symptom of diabetes insipidus
The first signs to think about pathology are polyuria and polydipsia. A child can drink up to 12 liters of cold water per day. Warm liquid and sweet juices can not quench the feeling of constant thirst. Urination occurs frequently. At one time, the sick baby can release up to 700 ml of clear and colorless urine. Frequent incontinence becomes a phenomenon, because of which children of school age are very complex.
Against the background of constant urine excretion, dehydration is rapidly developing. This is especially true for infants, as they cannot explain their desire to drink. The child begins to lose weight, dry skin and mucous membranes appear, tears are not visible when crying, a small amount of saliva is secreted.
Children complain of frequent nausea, abdominal pain, pain in the joints and muscles. The heart and blood vessels, as a rule, are not affected. Some babies may have heart palpitations and drops in blood pressure.
Critical dehydration in diabetes mellitus is manifested by the following symptoms:
- Strong headache;
- bouts of nausea and vomiting;
- expressed concern;
- a sharp decrease in the level of vision, feeling of a veil before the eyes;
- decrease in body temperature;
- rapid pulse;
- cognitive impairment;
- baby urinates by itself.
In parallel with the symptoms of diabetes insipidus, there may be changes in the work of other endocrine glands. A child may suffer from cachexia, dwarfism or gigantism (growth hormone pathology), developmental delay, menstrual disorders in adolescents.
A congenital renal form of the disease may be accompanied by a clinical picture in the first six months of the baby’s life. Abundant urination does not respond to the use of vasopressin analogues. Parents complain about the development of constipation in children, the occurrence of vomiting, fever.
The amount of urine released per day reaches 2000 ml. Seizures, impaired consciousness, and a critical reduction in blood pressure may develop.
Diabetes insipidus in children and adolescents is confirmed on the basis of clinical and laboratory data. The attending specialist clarifies when the first manifestations of the disease appeared, establishes their possible connection with mechanical injuries, neuroinfections. The daily amount of urine and the degree of dehydration of the body, the rate of progression of symptoms, the presence of sick relatives are determined.
The following diagnostic methods are performed:
- daily measurement of the amount of urine (daily diuresis);
- general urine analysis;
- urine analysis according to Zimnitsky;
- clarifying the presence of sugar and protein in the analysis;
- blood biochemistry with quantitative indicators of electrolytes, urea, creatinine, sugar, cholesterol;
- acid-base balance.
Urinalysis - the main method of laboratory diagnosis for suspected endocrine pathology
Dehydration (concentration) test
Begin diagnosis, as a rule, at 6 o'clock in the morning. The examined child is allowed to eat only solid food. Water and any other liquid should be discarded for the period indicated by the attending physician (from 4 to 6 hours, in adults - up to 24 hours).
The method is allowed exclusively in the hospital under the supervision of qualified professionals. Confirmation of the disease occurs on the basis of weight loss of the child and the same low specific weight of urine.
Test with vasopressin analog
Desmopressin was previously used, Mininir is now being used more and more. The purpose of the drug is accompanied by an increase in urine specific gravity and a decrease in its excretion in those children who have a central form of diabetes insipidus. Renal type of the disease is not accompanied by similar manifestations.
These diagnostic methods are necessary in order to identify the main cause of the central form of the disease. Preference is given to the following research methods:
- In the central form: X-ray of the skull; MRI of the brain; CT scan of the chest and abdominal cavity.
- Nephrogenic type: kidney ultrasound; Addis-Kakovsky test; excretory urography.
Important! Consultation of an ophthalmologist, neurosurgeon, neurologist.
Differentiation of the diagnosis
To make the correct diagnosis, it is necessary to differentiate between diabetes insipidus and those pathologies that manifest similar symptoms. Features and differences are listed in the table.
|What is the differentiation||What a disease||The main differences|
|Psychogenic polydipsia||Excessive urine in the background of mental disorders||Lab data are similar. For the difference, a dehydration test is used: the amount of urine excreted decreases, the specific density rises, the general state of health does not change|
|Kidney failure||The pathology of the kidneys, which is characterized by the violation of all functions leading to disorders of water-electrolyte, nitrogen and other metabolic processes||Minor polyuria, specific density in the range of 1010-1012, in the analysis of urine protein substances and cylinders are determined, blood pressure is above the norm|
|Diabetes||Insufficiency of insulin production by the pancreas or loss of sensitivity of cells and tissues to it||In the analysis of blood and urine sugar is detected, the specific density of urine is high. Rarely, but a combination of non-sugar and diabetes in one patient is possible.|
|Hyperparathyroidism||Excess hormone production by parathyroid glands||The specific density of urine is reduced slightly, the amount of calcium in biological fluids of the body increases|
|Albright syndrome||Malformation of bone tissue with its replacement with cartilaginous elements||A large amount of calcium and phosphorus is excreted in the urine, which leads to pathologies of the musculoskeletal system|
|Hyperaldosteronism||Excessive production of the hormone aldosterone by the adrenal glands||In addition to polyuria, characterized by convulsions, impaired sensitivity, increased blood pressure. There is little potassium in the blood, chloride, a lot of sodium|
|Nefronoftiz Fanconi||Hereditary pathology that develops in preschool age. Characterized by the formation of cysts in the kidney tissue at the level of collecting tubules||With the progression of the disease, high levels of urea appear, the acidity of the blood shifts towards acidosis, low blood potassium levels|
Features of the treatment of children
The first recommended diet. Kids do not add salt during cooking. Meals should be frequent, but in small portions. Increase the amount of fruits and vegetables in the diet, dairy products and fish. Children should drink as much as they wish. It is necessary for the prevention of dehydration. Babies are given ordinary water, weak tea, diluted juices and fruit drinks.
Treatment of the disease depends on which form of diabetes insipidus is present in this clinical case. In the central form of the disease, substitution therapy is used with the introduction of drugs based on antidiuretic hormone.
Children are recommended to use the tablet form of Desmopressin or Adiurecrin in the form of an ointment. The remaining drugs are available in the form of powder for inhalation through the nose. They are inconvenient for use in children, since inhalation may cause the drug to get into the eyes.
Children may be given the drug Chlorpropamid. It is used in the treatment of non-insulin-dependent diabetes mellitus, however, with a non-sugar form of the disease, it is able to reduce the daily urine output by half. It must be remembered that the drug can reduce blood sugar levels, so it is important to control glycemia using laboratory methods.
Minirin - one of the representatives of the analogues of antidiuretic hormone
A prerequisite for the treatment of central diabetes is to eliminate the causes of its development. If possible, tumor processes are operated, antibiotics, NSAIDs, antihistamines and dehydration agents are prescribed for infections.
If an autoimmune factor is present in the mechanism of development of the disease, it is important to use hormonal drugs. The effectiveness of this treatment is observed if the pathology is detected in the early stages.
Treatment of renal type disease
In this case, there is no specific therapy. Thiazide diuretic preparations show efficacy. The result is an increase in the osmotic concentration of urine and a proportional decrease in its volume. This action can achieve NSAIDs. To enhance the effectiveness of combining these two groups of drugs.
The prognosis of the outcome of the disease depends on the cause of its occurrence. Children should be observed at the endocrinologist and undergo laboratory tests once a quarter. Examination of the ophthalmologist and neuropathologist - every six months, CT scan and x-ray of the head - once a year.