Intipidus diabetes waena - ke hoʻomaopopo nei i kēia wā i ka maʻi a me ka mālama

Diipio maʻi maʻi insipidus (ND) (Latin diabetes insipidus) - kahi maʻi i hōʻino ʻia e ka hōʻino ʻana o ka synt synt, secretion or action of vasopressin, i hōʻike ʻia e ka ʻaha o ka nui o ka nui o ka waiʻai me ka hoʻohaʻahaʻa haʻahaʻa haʻahaʻa (hypotonic polyuria), ka huhū a me ka makewai.
Epidemiology. ʻO ka laha o ND i nā lehulehu ākea e like me 0.004% a 0,01%. Aia kahi ʻano honua i ka piʻi ʻana o ka pā mua o ND, ka kiko o kona ʻano kikowaena, ka mea i pili me ka piʻi ʻana o ka nui o nā hōʻiliʻili o ka maʻi i hana ʻia ma ka lolo, a me ka nui o nā hōʻeha craniocerebral, ma kahi o nā hanana hoʻomohala o ND no kahi o 30%. Ke manaʻoʻiʻo ia ua hoʻopili like ka ND i nā wahine a me nā kāne. ʻO ka ulu haʻahaʻa ma ke kau he 20-30 mau makahiki.

Pūnaewele Protocol: Diipio maʻi maʻi insipidus

ʻ (lelo (nā code) ma muli o ICD-10:
E23.2 - Diipeta indipidus

Nā lā hana hoʻomalu: ʻApelila 2013

Hoʻopau wale ia i hoʻohana i ka Protocol:
ND - diabetes insipidus
PP - polydipsia mua
MRI - ka imaging magneton resonance
HELL - ke kahawai koko
Naʻi maʻi mellitus
Ui - Ultrehana
ʻŌpala Gastrointestinal
Nā NSAIDs - nā lāʻau lapaʻau anti-inflammatory aʻaʻoleʻole
Nā CMV - cytomegalovirus

Kākau Pelekikena: nā kāne a me nā wahine he 20 a 30 mau makahiki, ka mōʻaukala o nā hōʻeha, ka wawa lima neurosurgical, ʻeha (craniopharyngoma, germinoma, glioma, etc.), nā maʻi o ka maʻi (congenital CMV infection, toxoplasmosis, encephalitis, meningitis).

Nā Pūnaewele Protocol: kauka lōkōlani, endocrinologist o kahi polyclinic a i haukapila paha, ka neurosurgeon o ka haukapila, ka haukapila trauma lapaʻau, pediatrician apana.

Kahi helu

Hoʻololi ʻano mālamalama:
Ka mea maʻamau:
1. Central (hypothalamic, pituitary), ma muli o ke synta impaired a me ka hiʻu ʻana o nā vasopressin.
2. Nā Neprogenic (renal, vasopressin - kū'ē), hōʻailona i ka pale ʻana o ke keiki i ka vasopressin.
3. polydipsia mua: kahi maʻi i ka wa a make i ka make ʻana o ka pathological (dipsogenic polydipsia) a i kahi makemake koi e inu (psychogenic polydipsia) a me ka pili nui i ka wai me ka wai ʻole i ka hoʻowalewale i ka punawai o ka vasopressin, ka hopena i nā hōʻailona ʻano o ka maʻi insipidus ma ke ʻano, a ʻo ke ʻano o ka vasopressin e alakaʻi i ka dehydration ua kau hou ʻia.

ʻO kekahi mau ʻano ʻē aʻe o ka maʻi insipidus maʻi ʻokoʻa ʻē aʻe nō hoʻi:
1. ʻO Progestogen e pili ana i ka hana nui o ka enzyme plasenta - arginine aminopeptidase, ka mea e hoʻopau ai i ka vasopressin. Ma hope o ka hānau keiki ʻana, hoʻonui ʻia ke kūlana.
2. Ka hana: e hana i nā keiki o ka makahiki mua o ke ola a ua kumu ʻia e ka immaturity o ke kaohi ʻana o ka hoʻoulu ʻana o ka pēpē a hoʻonui i ke ʻano o ka phosphodiesterase type 5, ka mea e alakaʻi i ka wikiwiki o ka mea hoihoi no ka vasopressin a me ka wā pōkole o ka vasopressin.
3. Iatrogenic: ka hoʻohanaʻana o diuretics.

Ka helu ʻana o ND e like me ka nui o ka papa.
1. aloha - mīke a hiki i ka 6-8 l / lā me ka mālama ʻole ʻana,
2. midi - hoʻopuka urine a hiki i ka 8-14 l / lā me kaʻole o ka mālama ʻana,
3. koʻikoʻi - urination o ʻoi aku ma mua o 14 l / lā me ka mālama ʻole ʻana.

Ka helu ʻana o ND e like me ke ʻano o ka uku:
1. uku - i ka mālama ʻana i ka makewai a me ka polyuria ʻaʻole e hoʻopilikia,
2. subcompensation - i ka wā mālama ana aia nā manawa make wai a me ka polyuria i ka lā,
3. decompensation - hoʻomau ka make ʻana a me ka polyuria.

Naʻi hoʻolika

ʻO ka papa inoa o nā kumu maoli a me nā mea maʻi hou aʻe.
Nā hana Diagnostic ma mua o kahi hoʻokolohua i hoʻolālā ʻia:
- ka nānā ʻana i ka urine,
- ka nānāʻana biochemical i ke koko (ka paʻakai, ka sodium, ka nui o ka calcium, ka calciumionized, glucose, ka momona, ka urea, ka mea hana, ka osmolality koko),
- ka loiloi o ka diuresis (> 40 ml / kg / lā,> 2l / m2 / lā, osmolality o ka urine, pilina pili).

ʻO nā mea hoʻonā nui nui:
- e ʻālau me ka ʻai maloʻo (hoʻāʻo ka pāʻina),
- Hōʻoia me ka desmopressin,
- MRI o ka palena hypothalamic-pituitary

Nā hana ʻokoʻa hou aʻe:
- ʻākahi pūpū,
- nā ulia papa hana hoʻohālike

Nā hōʻailona Diagnostic:
Nā hoʻopiʻi a me nā anamnesis:
Hōʻike ʻia nā hōʻike nui o ND polyuria (ka hopena i ka urine ma mua o 2 l / m2 i hoʻokahi lā a i ʻole 40 ml / kg i kēlā lā i nā keiki makua a me nā mākua), polydipsia (3-18 l / lā) a me nā pilikia hiamoe. ʻO kahi makemake no ka wai anuanu / wai wai i keʻano. Aia paha ka ʻōpala maloʻo a me ka membula o ka mucous, hoʻemi ʻia i ka salivation a me ka lulu. Hoʻokuʻu ʻia ka ʻauwaʻa. Ma muli o ka hōʻeha o nā hōʻailona pili i ke kiʻekiʻe o ka maʻi neurosecretory. Me ka hapaʻole o ka vasopressin, ʻaʻole ʻike like paha nā hōʻailona lapaʻau a ʻike ʻia i nā kūlana wai ʻole o ka waiʻona a i ʻole ka nui o ke kahe. I ka hōʻiliʻili ʻana i kahi anamnesis, pono e hoʻomaikaʻi i ka lōʻihi a me ka hoʻomau o nā hōʻailona i nā maʻi, ka loaʻa ʻana o nā hōʻailona o ka polydipsia, polyuria, ka maʻi maʻi i nā hoahānau, nā moʻolelo o nā hōʻeha, nā wawaʻi neurosurgical, ʻeha (craniopharyngioma, germinoma, glioma, etc.), nā maʻi (congenital CMV infection. , toxoplasmosis, encephalitis, meningitis).
I nā pēpē a me nā pēpē, ʻokoʻa ka kiʻi kino o ka maʻi o ka maʻi ma mua o nā pākeke, no ka mea, ʻaʻole hiki iā lākou ke haʻi i ko lākou makemake no ka nui o ka komo ʻana o ka lolo, ka mea e hoʻopiʻi i ka maʻi wā kūpono a hiki ke alakaʻi i ka hōʻoli ʻana o ka ʻōpio hiki ʻole ke hoʻoweliweli. Hiki i kēlā mau mea maʻi ke loaʻa ka pohō kaumaha, ka maloʻo a me ka palaka, i ka nele o nā waimaka a me ka palau, a me ke hoʻonui ʻana o ke ʻano o ke kino. Pane lākou paha i ka waiū umauma i ka wai, a i kekahi manawa ua lilo nā maʻi ma hope wale nō o ka uha ʻana i ke pēpē. He haʻahaʻa loa ka osmolality i ka wai a nānā ʻole i ka 150-200 mosmol / kg, akā ʻike wale ka polyuria ma kahi o ka hoʻonui ʻana o ka nui o ka hoʻohana ʻana i ka wai. I nā keiki o kēia wā ʻōpiopio, ʻo ka hypernatremia a me ka hyperosmolality o ke koko me nā mea kuʻi a me nā coma pinepine pinepine i ka ulu.
I nā keiki kahiko, hiki mai ka makewai a me ka polyuria ma mua o nā hōʻailona haumania, me ka loaʻa ʻole o ka nui o ka wai, hiki i nā episode hypernatremia ke hele, hiki i ka holomua a me nā kiki. Ke ulu maikaʻi nei nā keiki a loaʻa ke kaumaha, ʻohi pinepine lākou i ka wā e ʻai ai, nele i ka momona, nā kūlana hypotonic, constipation, retardation noʻonoʻo. Hōʻike wale ka maʻi hypertonic daphdration ma nā hihia wale nō o ka loaʻa ʻole o nā kahe.

ʻO ka nānā kino:
I ka hoʻokolohua, ʻike ʻia nā hōʻailona dehydration: ka maloʻo maloʻo a me nā membrane mucous. ʻO ke kahe nui o ke systolic e hele a hewila paha i hōʻemi ʻia, hoʻonui ʻia ke koko diastolic.

Laboratory noiʻi:
Wahi a ka loiloi laulā o ka urine, wehe ʻia ia, ʻaʻole ia i nā mea pathological ʻano, me ka haʻahaʻa haʻahaʻa haʻahaʻa (1,000-1,005).
No ka hoʻoholoʻana i ka hiki ke ʻike i nā pūlima, lawe ʻia kahi hōʻike e like me Zimnitsky. Inā mahele o kekahi mahele o ka nui o ka urine ke kiʻekiʻe aʻe ma mua o 1.010, a laila hiki ke hoʻokaʻawale ʻia ka hōʻike ʻana o ka ND, no laila, e hoʻomanaʻo ʻoe i ka loaʻa o ke kō a me ke kō i loko o ka urine e hoʻonui i ka nui o ka maʻamau o ka urine.
ʻO ka hyperosmolality Plasma heʻoi aku i ka 300 mosmol / kg. ʻO ka maʻamau, ʻo ka osmolality plasma he 280-290 mosmol / kg.
ʻO ka hypoosmolality o ka urine (ʻoi aku ma mua o 300 mosmol / kg).
ʻO Hypernatremia (ʻoi aku ma mua o ka 155 meq / l).
Me kahi kiko waena o ND, kahi i emi iho nei o ka hōʻemi o ka pae o vasopressin i loko o ka serum koko, a me ka ʻano nephrogenic, he mea maʻamau a hamama nui paha.
Kūʻai hoʻoliʻi (hoʻāʻo me ka papa ʻai maloʻo). G.I. Ka Palapala Hoʻoheno ʻO Kekemaha Robertson (2001).
Hoʻoikaika palapala:
- lawe i ke koko no ka osmolality a me ka sodium (1)
- e hōʻiliʻili i ka urine e hoʻoholo i ka nui a me ka osmolality (2)
- kau ana i ke kaupaona maʻi (3)
- ka hoʻomalu ʻana i ke koko a me ka puʻuwai puʻuwai (4)
Ma hope aku, ma nā kaulike like o ka manawa, e pili ana i ke ʻano o ka mea maʻi, e hana hou i nā alapine 1-4 ma hope o 1 a i ʻole 2 mau hola.
ʻAʻole ʻae ʻia ka mea maʻi e inu, ʻōlelo ʻia nō ia e kaupalena i ka ʻai, ʻo ka liʻiliʻi loa i ka mau hola 8 mua o ka hoʻokolohua .. I ka wā e hānai ai i ka ʻai, ʻaʻole pono e loaʻa i ka wai he nui a me nā kūmole hāmama, kūwīwī, ʻai palaoa, ʻōpala haʻahaʻa, makemake ʻia nā iʻa.
Pau ka ʻatikala i ka:
- liloi a keu aku ma kahi o 5% o ke kaumaha o ke kino
- ka makewai hiki ʻole ke kala
- kūlohelohe koʻikoʻi o ke ahonui
- ke hoʻonui o ka sodium a me ka osmolality koko ma luna o nā palena maʻamau.

Hōʻike Desmopressin. ^ E Ha yM. Ke lawe ʻia nei ka hōʻike ma hope o ka pau o ka hōʻike dehydration, i ka manawa i hiki ai i ka nui loa o ka huna ʻia / hana i ka vogenoplinin endogenous. Hāʻawi ka mea maʻi i ka 0.1 mg o ka papa desmopressin ma lalo o ka alelo a hiki i ka resorption a i ʻole 10 μg intranasally ma ke ʻano o kahi pāʻai. Hoʻonohonoho ʻia ka osmolality urine ma mua o desmopressin a me 2 a me 4 mau hola ma hope o ka hana. I ka wā o ka hoʻokolohua, ʻae ʻia ka mea inu e inu, akā ʻaʻole iʻoi aku ma mua o 1.5 mau manawa o ka urine i hoʻopuka ʻia, ma kahi hoʻokūkū luʻu.
ʻO ka wehewehe ʻana i nā hopena hoʻokolohua me ka desmopressin: Aia ka hopena o ka polydipsia maʻamau a i ʻole ka hopena o ka urine ma luna o 600-700 mosmol / kg, ka noho mau o ka koko a me ka sodium i loko o nā palena maʻamau, ʻaʻole e loli maoli ka maikaʻi. ʻAʻole e hoʻonui ʻo Desmopressin i ka osmolality o ka urine, no ka mea ua hōʻea ʻo ia i kona nui kiʻekiʻe.
Me ka kikowaena ND, ʻo ka osmolality urine i ka wā o ka hoʻoilo, ʻaʻole iʻoi aʻe i ka osmolality koko a noho mau ma ka liʻiliʻi o 300 mosmol / kg, hoʻonaninani a me ka sodium osmolality, hōʻailona hōʻoliʻalaha, nā maloʻo mucous nui, hoʻonui a hoʻoemi paha i ke kahe koko, tachycardia. Me ka hoʻomakaʻana o ka desmopressin, hoʻonui ka osmolality o ka urine ma mua o 50%. Me ka nephrogenic ND, ke ʻano o ka osmolality o ke koko a me ka paʻakai, ʻoi aku ka osmolality o ka urine ma mua o 300 mosmol / kg e like me ka waena o ND, akā ma hope o ka hoʻohana ʻana i ka desmopressin, ʻaʻole ka hoʻonui o ka osmolality o ka urine (ʻoi ka piʻi a hiki i 50%).
ʻO ka wehewehe ʻana i nā hopena o nā hōʻike i hōʻike ʻia i loko o nā pā. . ^ E Ha yM.

Ke noiʻi noiʻi:
Ua manaʻo ʻia ʻo ND Central kahi mākaʻikaʻi o ke ʻano o ke ala o ka wahi hypothalamic-pituitary. ʻO Brain MRI ke ʻano o ke koho i ka maʻi ʻana i nā maʻi maʻi o ka ʻāina hypothalamic-pituitary. Me ka kikowaena ND, loaʻa i kēia ʻano nā pono āpau ma luna o ka CT a me nā ʻano hana ʻē aʻe.
Hoʻohana ʻia ʻo Brain MRI e ʻike i nā kumu kumu o ka hana nui o ka ND (ʻo ka ʻōpū, nā maʻi maʻi infiltrative, nā maʻi granulomatous o ka hypothalamus a me ka hoʻopiha pituitary, a pēlā aku. ma ka dinamika, ʻoiai aia nā hihia i ka wā i kū ai ke kikowaena ND i kekahi mau makahiki ma mua o ka loaʻa ʻana o kahi maʻi maʻi

Nā hōʻailona no ka ʻōlelo aʻo loea.
Inā hele nā ​​loli pathological i loko o ka wahi hypothalamic-pituitary, ke kuhikuhi ʻia nā kūkākūkā ʻana o kahi neurosurgeon a me kahi ʻōmaiʻiwa. Inā ʻike ʻia kahi pelolo o ka ʻōnaehana urinary - a urologist, a i ka wā e hōʻoia ʻia ai ka ʻano o ka psychogen varied o ka polydipsia, pono i ke kūkākūkā me ka psychiatrist a i ʻole neuropsychiatrist.

Synthesis a me ka hiʻona o ka hormone antidiuretic

Hoʻopiliʻia ka hormone antidiuretic vasopressin i ka supraoptic a me ka paraventricular nuclei o ka hypothalamus. Hoʻokaʻaina aku i ka neurophysin, ka mea paʻakikī i ke ʻano o ka granules e lawe ʻia ana i nā hōʻano hou o nā axons o ka neurohypophysis a me ka kiʻekiʻe median. Ma ka axon ua pili i ka pilina me nā capillaries, hōʻiliʻili ka ADH. Wahi a ADH huna i ka osmolality plasma, ka neʻe i ka nui koko a me ke koko. E pili ana nā ʻōleʻa osmotically i nā wahi kokoke i ka ventricular o ke aniani hypothalamus e hoʻololi i ka hoʻololi ʻana i ka hoʻolālā electrolyte o ke koko. Hoʻonui ka hana o osmoreceptors me ka hoʻonui i ka osmolality koko e hoʻoikaika i nā neurons vasopressinergic, mai nā kihi o ka vasopressin i hoʻokuʻu i ka kahe koko. Ma lalo o nā kūlana pilikino, aia ka osmolality plasma ma ka waena o 282-300 mOsm / kg. ʻO ka maʻamau, ʻo ka paepae no ka ʻōlelo huna o ka ADH ʻo ka osmolality o ke kaila koko e hoʻomaka ana mai 280 mauʻOm / kg. Hiki ke ʻike ʻia nā ʻike haʻahaʻa no ka huna ʻana o ka ADH i ka wā hāpai, nā maʻi ʻeha, a me nā maʻi oncological. Hoʻolaha ka osmolality plasma i lawe ʻia e ka hoʻokomo ʻana i ka nui o ka wai i hoʻopaʻa i ka mea huna o ADH. Me ka pae o ka osmolality plasma ma mua o 295 mau mOsm / kg, ua hoʻonui ʻia ka hoʻonui ʻia ʻana o ka huna ʻana a ADH a me ka hana ʻana o ka huina makewai. ʻO ke kikowaena o ka makewai a me ka ADH, e kāohi ʻia e ka osmoreceptors o ka vascular plexus o ka ʻāpana anterior o ka hypothalamus, e pale i ka make wai o ke kino.

ʻO ke hoʻoponopono o ka huna ʻia o vasopressin e hilinaʻi hoʻi i nā loli i ka nui o ke koko. Me ka hoʻohemo ʻana, he hopena koʻikoʻi nā volumoreceptors e waiho ana ma ka atrium hema i ka huna ʻana o nā vasopressin. I loko o nā kīʻaha, e hana kahe koko, e loaʻa ana i nā mākene palupalu o nā mehe o ke koko. ʻO ka hopena o vasoconstrictive o vasopressin i ka wā o ka nalowale o ke koko ma muli o kahi hōʻemi o ke kaila neʻe o ka palupalu o ka moku, e pale ana i ka hāʻule ʻana o ke koko. Me ka hoʻohaʻahaʻa ʻana i ke kahe koko e ʻoi aku ma mua o ka 40%, ʻoi aku ka nui o ka pae o ka ADH, 100 mau manawa kiʻekiʻe loa ma mua o kona paepae basal o 1, 3. ʻO Baroreceptors e loaʻa ana i ka sinus carotid a me ka archae aortic pane i ka hoʻonui ʻana i ke koko, a hiki i ka hopena i ke kahe ʻana o ka hoʻolaha ADH. Eia kekahi, hoʻopili ʻo ADH i ka hoʻoponopono ʻana o ka hemostasis, ka hōʻailona o ka prostaglandins, a paipai i ka hoʻokuʻu ʻana o renin.

Nā kinikini sodium a me mannitol he mau mea hoʻoikaika i ka hoʻoweliweli vasopressin. ʻAʻole ʻae ʻo Urea i ka ʻōheu o ka hona, a alakaʻi ka glucose i ka pale ʻana o kāna hili.

ʻO ka hana o ka hana o ka hormone antidiuretic

ʻO ADH ka mea hoʻoponopono koʻikoʻi o ka mālama wai ʻana a hoʻolako i ka homeostasis wai e hui pū me ka hormone natriuretic atrial, ald testosterone a me ka angiotensin II.

ʻO ka hopena koʻikoʻi o ka vasopressin e hoʻoulu i ka reabsorption wai i loko o ka ʻohi o nā tubule o ka cortex renal a me ka medulla e kū'ē ana i ka gradient pressure osmotic.

I loko o nā loko o nā pūlani renal, hana a ADH ma o (type type 2 vasopressin receptor), aia i nā kola basolateral o nā puna o nā puna ʻohi. ʻO ka pilina o ADH me ke alakaʻi i ka hoʻopololei ʻana i ka cyclase adenylate-vasopressin-sensitive a me ka hoʻonui i ka hana ʻana o ka monophosphate cyclic (AMP). Hoʻokomo ʻia ʻo Cyclic AMP i ka protein kinase A, ma ka mea e hoʻoulu ai i ka hoʻopili ʻana o nā polokalamu wai o ka wai o loko o nā puʻupuʻu apical. Mālama kēia i ka lawe ʻana o ka wai mai loko o ka lumen o ka puna ʻohi i loko o ke kō a ma o waho: ma o ke kīleʻa o nā kahawai wai ma loko o ka membm basolateral a lawe ʻia ka wai i loko o ka wahi intercellular, a laila komo i loko o nā moku koko. A ke hopena, kūkulu ʻia ka urine me ka osmolality kiʻekiʻe.

ʻO ka ʻekiko Osmotic ka laulā o ka pau ʻana o nā ʻāpana āpau. Hiki ke hoʻākāka ia me ka osmolarity a hoʻopaʻa ʻia i ka osmol / l a i ʻole osmolality i osmol / kg. ʻO ka ʻokoʻa ma waena o ka osmolarity a me ka osmolality e kau i ke ala e loaʻa ai kēia waiwai. No ka osmolarity, kahi kaʻina hana kēia no ka hoʻopaʻaʻana o nā electrolytes kumu maʻamau i loko o ka wai i hoʻopaʻa ʻia. Ke ʻano hoʻonaninani no ka osmolarity:

Kahumoku = 2 x + kaomi (mmol / l) + urea (mmol / l) + 0,03 x huapalapala nui ().

ʻO ka osmolality o nā kaila, ka urine a me nā waiʻaola e hoʻopili ai i ka osmotic pressure, ka mea e hilinaʻi nei i ka nui o nā oons, ka glucose a me ka urea, i hoʻoholo ʻia e hoʻohana ana i kahi polokalamu osmometer. ʻOi aku ka Osmolality ma mua o ka osmolarity e ka nui o ke kaomi oncotic.

Me nā mea huna pilikino o ADH, ʻoi aku ka pīmole osmolarity ma mua o 300 mOsm / l a hiki ke hoʻonui i 1200 mOsm / l a ʻoi aku ke kiʻekiʻe. Me ka nele o ka ADH, urm osmolality ma lalo o 200 mosm / l 4, 5.

Nā mea Etiological o ke kūloko diabetes insipidus

Ma waena o nā kumu kumu nui o ka hoʻomohala ʻana o LPC, kahi ʻano hoʻoilina ʻohana hoʻoilina o ka maʻi e hoʻohemo ʻia e ka hoʻoilina ʻia a i ʻole ke hoʻoilina. Hiki ke paʻi ʻia ka maʻi o ka maʻi i kekahi mau hanauna a hiki ke hoʻopilikia i ka nui o nā ʻohana, no ka mutations e alakaʻi ana i nā loli i ke ʻano o ka ADH (DIDMOAD syndrome). ʻO nā hemahema o ka ʻenekine kongenital ma ke kūkulu ʻana o ka waena ma ka diencephalon hiki ke kumu mua o ka hoʻomohala ʻana i ka maʻi puʻuwai haʻahaʻa. I nā 50-60% o nā hihia, ʻaʻole hiki ke hoʻokumu ʻia ke kumu kumu o ka ʻehaʻeha hoʻemi ʻole - ʻo ia ka mea i kapa ʻia ʻo ka maʻi maʻamau o ka maʻi opioid.

Ma waena o nā kumu lua e alakaʻi i ke ʻano o ka hoʻopili o ka nūna o ka ʻōpala, nā trauma (concussion, hōʻeha i ka maka, hōʻeha ʻia i ke kumu o ka ʻōpala.

Hiki ke hoʻopili ʻia ka hoʻomohala ʻana o ka NSD kūloko i nā kūlana ma hope o ka hana transcranial a i ʻole transsphenoidal ma ka pituitary gland no ka ʻoi ʻana o ka lolo e like me ka craniopharyngioma, pinealoma, germinoma, e alakaʻi ana i ka hoʻōheʻe a me ka hiʻona o nā kelopona posterior pituitary.

ʻO ka hoʻololi ʻana o ka maʻi i ka hypothalamus, supraopticohypophysial tract, funnel, wāwae, posterior pituitary gland kekahi mau kumu lua o ka hoʻomohala ʻana i ke kaomi haʻahaʻa.

ʻO ke kumu alakaʻi i ka hoʻomaka ʻana o kahi ʻano kūlohelohe o ka maʻi. Mawaena o nā maʻi lēʻeha, ka maʻi, ka encephalitis, meningitis, tonsillitis, ʻulaʻula, ʻokoʻa ka ʻōpala wai i waena o nā maʻi hopohopo - tuberkulosis, brucellosis, syphilis, malaria, rheumatism 9, 10.

I waena o nā kumu kumu vascular o displasia neural low low pressure he Skien's syndrome, ka huina koko hoʻoweliweli i ka neurohypophysis, thrombosis, a me ka aneurysm.

Aia ma kahi o ke anatomical, hiki i ka LPC ke noho mau a transient paha. Me ka hanaʻino o ka nuclei supraoptic a paraventricular, ʻaʻole i mau i ka hana ADH.

Kūkulu ʻia ka hoʻolālā ʻana o ka nephrogenic ND i ka congenital receptor a i ʻole nā ​​hanana enzymatic o nā tubule distal o nā keiki, ke alakaʻi nei i ke kū'ē o nā receptors i ka hana a ADH. I kēia hihia, hiki i nā loina o ka endogenous ADH ke hana i a i ʻole e hāpai ʻia, a me ka lawe ʻana aku i ka ADH ʻaʻole i kāpae i nā hōʻailona o ka maʻi. Hiki i ka Nīkini neʻīlani i ka maʻi maʻamau o ka maʻi o ka urinary tract, urolithiasis (ICD), a me nā prostate adenoma.

Hiki i ke nephrogenic ND neʻeola neʻe i loko o nā maʻi i hele pū ʻia e ka poʻokela o nā tubal distal o nā keiki, e like me ka anemia, sarcoidosis, amyloidosis. I nā kūlana o ka hypercalcemia, hoʻemi ka ʻili o ka ADH a me ka hoʻohaʻahaʻa ʻana i ka wai.

Hoʻokumu ka polydipsia Psychogenic ma ke ʻano o ka nupepa ma mua o nā wāhine o nā kāne menopausal (Papa 1). ʻO ka ulu mua o ka make wai ma muli o nā maʻi i hana i ka pokapū o ka makewai. Ma lalo o ka mana o ka nui o ka wai a me ka hoʻonui nui ʻana o ka nui o ka plasma i neʻe, ua hoʻemi ʻia ka emi ʻana o ka mea huna ADH ma o ka mīkini baroreceptor. A urinalysis e like me Zimnitsky i loko o kēia mau maʻi e hōʻike ana i kahi hoʻohaʻahaʻa i ka palena pilikino, aʻo ke koʻo o ka sodium a me ka osmolarity o ke koko e noho maʻamau a hōʻemi paha. Ke hoʻokapu nei i ka pau ʻana o ka inu wai, hoʻomau ka maikaʻi o ka poʻe maʻi, ʻoiai ka nui o ka urine, a laila e piʻi ka ʻihi i ke palena o ka physiological.

ʻO ke kiʻi maʻi lapaʻau o ka maʻi maʻamau o ka maʻi insipidus

No ka hōʻike o ND, pono ia e hoʻemi i ka mea huna o ka hiki ʻana o ka neurohypophysis ma 85% 2, 8.

ʻO nā hōʻailona nui o ND ka nui o ka urination a me ka makewai nui. ʻO ka pinepine o ka nui o nā urine ma mua o 5 lita, hiki ke hele a hiki i 8-10 lita i kēlā me kēia lā.

Hoʻokumu ka Hyperosmolarity o ke kahe koko i ke kikowaena o ka makewai. ʻAʻole hiki i ka mea maʻi ke hana me ka lawe ʻole ʻana i ka wai no nā minuke he 30 mau. ʻO ka nui o nā wai e inu me kahi ʻano haʻahaʻa o ka maʻi e hōʻea i ka lita 3-5 lona, ​​me ka hōʻemi haʻahaʻa - 5-8 lita, me kahi ʻano koʻikoʻi - 10 lita a i ʻole. Hōʻalo ʻia ka urine; ʻo 1000 mau ka pilina. I nā kūlana o ka inu nui ʻana i ka wai maʻi ma ka mea maʻi, hoʻemi ka ʻōpū, ua pālahalaha ka ʻōpū, hoʻemi ʻia ka hiʻona ʻana, e hāhalo ana ka gastrointestinal i lalo, e ulu ana ka constipation. I ka hopena o ka hopena hypothalamic e ka hōʻeha a me ka hana traumatic, me ka ND, hiki ke ʻike ʻia nā maʻi ʻē aʻe, e like me ka ʻōpū, ka holomua ulu ʻana, galactorrhea, hypothyroidism, diabetes mellitus (DM) 3, 5. Me ka hoʻomau ʻana o ka maʻi, hele ka dehydration i ka malo maloʻo a me nā membula mucous, a me kahi hoʻēmi ʻana i ka wai lawaiʻa. - ka lula ʻana, ka hoʻomohala ʻana o ka stomatitis a me ka nasopharyngitis. Me ka hiʻona nui, nāwaliwali laulā, hoʻomaka ka palpitations e hoʻonui, e ʻike ʻia ana kahi emi o ke koko, ke piʻi nui ke poʻo, hiki ke ʻano. E lilo nā mea maʻi i ka huhū, aia paha he ala hallucitions, convulsions, collaptoid state.