Diabetes Case Study

If desmopressin reduces urine output and increases osmolarity, the pituitary production of ADH is deficient, and the kidney responds normally.

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Diabetes Insipidus resembles diabetes mellitus because the symptoms of both diseases are increased urination and thirst.

However, in every other respect, including the causes and treatment of the disorders, the diseases are completely unrelated.

The latter is usually referred to as primary polydipsia and is most often caused by an abnormality in the part of the brain that regulates thirst.

This subtype is difficult to differentiate from pituitary DI particularly since the two disorders can result from many of the same brain diseases.This increase in permeability allows for reabsorption of water into the bloodstream, thus concentrating the urine.1) Central or neurogenic DI- The most common type of DI is caused by a lack of vasopressin, a hormone that normally acts upon the kidney to reduce urine output by increasing the concentration of the urine.This type of DI is usually due to the destruction of the “posterior” part of the pituitary gland where vasopressin is normally produced. The posterior pituitary can be destroyed by a variety of underlying diseases including tumors, infections, head injuries (as in the given patient), infiltrations, and various inheritable defects.There is less water reabsorption and diuresis is promoted.Reverse occurs with a decreased intake of water, a concentrated urine is excreted due to more water reabsorption under the effect of ADH.The main effector organ for fluid homeostasis is the kidney.ADH acts by increasing water permeability in the collecting ducts and distal convoluted tubule, specifically it acts on proteins called aquaporins which open to allow water into the collecting duct cells(figure-3).In order to distinguish DI from other causes of excess urination, blood glucose levels, bicarbonate levels, and calcium levels need to be tested.Measurement of blood electrolytes can reveal a high sodium level (hypernatremia as dehydration develops).3) Nephrogenic DI -The third type of DI is caused by an inability of the kidneys to respond to the “antidiuretic effect” of normal amounts of vasopressin.The kidneys’ ability to respond to ADH can be impaired by drugs—like lithium, for example—and by chronic disorders including polycystic kidney disease, sickle-cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders.4) Dipsogenic DI –The fourth form of DI occurs when vasopressin is suppressed by excessive intake of fluids.

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