Central insipidus ọrịa shuga - nghọta dị ugbu a banyere nchoputa na ọgwụgwọ

Ọrịa mamịrị insipidus (ND) (Latin nke insipidus) - ọrịa nke mebiri na njikọta njikọta, usoro nzuzo ma ọ bụ omume nke vasopressin, nke gosipụtara site na mmamịrị nke nnukwu mmamịrị na-enwe ntakịrị nsogbu (hypotonic polyuria), akpịrị ịkpọ nkụ na akpịrị ịkpọ nkụ.
Ọrịa oria. Ọnụnọ nke ND na ndị bi n'ọtụtụ dịgasị iche site na 0.004% ruo 0.01%. Enwere echiche ụwa maka ịbawanye mgbasa nke ND, ọkachasị n'ihi n'ụdị ya etiti, nke a na-ejikọ na mmụba nke ọnụ ọgụgụ ịwa ahụ a rụrụ na ụbụrụ, yana ọnụ ọgụgụ mmerụ ahụ craniocerebral, na ọnọdụ nke akaụntụ mmepe mmepe nke ND maka ihe dịka 30%. Ekwenyere na ND na-emetụtakwa ma ụmụ nwanyị ma ụmụ nwoke. Ọnọdụ kachasị elu na-apụta na afọ 20-30 afọ.

Aha Protocol: Ọrịa mamịrị insipidus

Koodu (Koodu) dika ICD-10 siri di:
E23.2 - Diabetes insipidus

Datebọchị Protocol: Eprel 2013

Aha ndebiri eji na Protocol:
ND - ọrịa shuga insipidus
PP - polydipsia bụ isi
MRI - eserese ndọta
HELL - ọbara mgbali
Ọrịa shuga mellitus
Ultrasound - Ultrasound
Ọkpụkpụ afọ
NSAIDs - ọgwụ mgbochi na - abụghị ọgwụ steroidal
CMV - cytomegalovirus

Otu Ndidi: ụmụ nwoke na ụmụ nwanyị dị afọ 20 ruo 30, akụkọ banyere mmerụ ahụ, ihe ndị metụtara neurosurgical, etuto ahụ (craniopharyngoma, germinoma, glioma, wdg), ọrịa (ọrịa CMV congenital, toxoplasmosis, encephalitis, meningitis).

Ndị Ọrụ Protocol: dibia distrikti, endocrinologist nke polyclinic ma ọ bụ ụlọ ọgwụ, neurosurgeon ụlọ ọgwụ, dọkịta na-awa trauma, dọkịta pediatric.

Nkewa

Nhazi ọkwa:
Kacha nkịtị bụ:
1. Central (hypothalamic, pituitary), n'ihi nsị anụ ahụ yana nzuzo nke vasopressin.
2. Nephrogenic (gbasara akụrụ, vasopressin na - eguzogide), nke akwara sitere na iguzogide vasopressin.
3. polydipsia nke mbu: ọgba aghara mgbe akpịrị ịkpọ nkụ (dipsogenic polydipsia) ma ọ bụ mmachi ị toụ mmiri (psychogenic polydipsia) na oke mmiri na - egbochi mmiri ọgwụ nke vasopressin, na - ebute njirimara njirimara nke ọrịa shuga insipidus, ebe njikwa vasopress na - akpata nkụda mmụọ. a na-eweghachi.

Aredị ọrịa shuga ndị ọzọ na-adịghị ahụkebe na-iche:
1. Progestogen metụtara ụba ọrụ nke enzyme placenta - arginine aminopeptidase, nke na-ebibi vasopressin. Mgbe amuchara nwa, onodu ya di nma.
2. Ọrụ: pụtara na ụmụaka nke afọ mbụ nke ndụ ma ọ bụ kpatara ya site na ntozu oke nke ịta ahụ nke akụrụ na ụba ọrụ nke ụdị 5 phosphodiesterase, nke na-eduga n'iwepu ngwangwa nke nnabata maka vasopressin na obere oge nke vasopressin.
3. Iatrogenic: iji ọgwụ diuretics.

Nkebi nke ND dabere na ogo akwụkwọ ahụ siri dị:
1. dị nro - mmamịrị ruo 6-8 l / ụbọchị na-enweghị ọgwụgwọ,
2. ọkara - mmamịrị mmamịrị rue 8-14 l / ụbọchị n’enweghị ọgwụgwọ,
3. siri ike - urination nke ihe karịrị 14 l / ụbọchị na-enweghị ọgwụgwọ.

Nkewa nke ND site na nkwụghachi ụgwọ:
1. ụgwọ kwụrụ ụgwọ - na ọgwụgwọ nke akpịrị ịkpọ nkụ na polyuria anaghị enye nsogbu,
2. subcompensation - n'oge ọgwụgwọ enwere akụkụ akpịrị ịkpọ nkụ na polyuria n'ụbọchị,
3. decompensation - akpịrị ịkpọ nkụ na polyuria na-adịgide.

Diagnostics

Ndeputa uzo ozo
Nchọpụta usoro nyocha tupu ụlọ ọgwụ achọrọ:
nyocha nyocha nke mmamịrị,
- nyocha ihe banyere biochemical nke ọbara (potassium, sodium, calcium ngụkọta, calion ionized, glucose, protein dum, urea, creatinine, osmolality ọbara),
- ntule nke diuresis (> 40 ml / kg / ụbọchị,> 2l / m2 / ụbọchị, mmụba mmamịrị, oke nha).

Isi usoro nchọpụta:
- Ihe nlele na ahiri nri (inyocha oke),
- Nwalee desmopressin,
- MRI nke mpaghara hypothalamic-pituitary mpaghara

Usoro nyocha ọzọ:
- akụrụ ultrasound,
- Nnwale akụrụngwa nwa arụ ọrụ

Usoro nyocha:
Mkpesa na anamnesis:
Ngosiputa isi nke ND na-egosipụta polyuria (ihe mmamịrị nke ihe karịrị 2 l / m2 kwa ụbọchị ma ọ bụ 40 ml / n'arọ kwa ụbọchị na ụmụaka na ndị okenye), polydipsia (3-18 l / ụbọchị) na nsogbu ndị metụtara ụra. Mmasị maka mmiri oyi / akpụrụ mmiri nkịtị bụ njirimara. Enwere ike inwe akpịrị anụ na mucous membranes, belatara salivation na sweating. A na-ebelata agụụ. Ogo mgbaama nke mgbaàmà ya na-adabere na ogo nke neurosecretory insufficiency. Site na mwepu nke vasopressin na-ele mmadụ anya n'ihu, mgbaàmà nke ọrịa enweghị ike ọfụma ma pụta na ọnọdụ ịriụ mmanya ma ọ bụ oke mmiri. Mgbe ị na-achịkọta ihe anamnesis, ọ dị mkpa ịkọwapụta oge na ọnụnọ nke ihe mgbaàmà na ndị ọrịa, ọnụnọ nke ihe mgbaàmà nke polydipsia, polyuria, ọrịa shuga na ndị ikwu, akụkọ banyere mmerụ ahụ, ntanetị neurosurgical, tumor (craniopharyngioma, germinoma, glioma, wdg), ọrịa (congenital CMV infection virus , toxoplasmosis, encephalitis, meningitis).
N'ime ụmụ amụrụ ọhụrụ na ụmụ ọhụrụ, onyonyo onyonyo nke ọrịa a dị ezigbo iche na nke ndị okenye, n'ihi na ha enweghị ike ịkọwapụta agụụ ha maka ịba ụba oke mmiri, nke na-agbagha nchọpụta oge ma nwee ike ibute mmepe nke ụbụrụ mmebi. Ndị ọrịa dị otú a nwere ike ịta ahụ, akpọnwụ akpọnwụ na nke na-acha odo odo, enweghị anya mmiri na ọsụsọ, yana mmụba nke ahụ ọkụ. Ha nwere ike ịhọrọ mmiri ara ara na mmiri, mgbe ụfọdụkwa ọrịa a na-apụta na-enwe ọnwu nanị mgbe a kwụsịrị nwa ahụ. Osmolality urine dị ala ma ọ dịkarịa ala karịa kilogram 150-200, ma polyuria na-apụta naanị ma ọ bụrụ na mmụba ụmụaka na-aba ụba. N’aka umuaka, umuaka na aru nke obara ndi nwere oria na agba mgbe nile na etolite etolite.
N'ime ụmụaka toro, akpịrị ịkpọ nkụ na polyuria nwere ike ịbịa na mgbaàmà nke ọrịa, yana mmiri zuru oke, nsogbu nke hypernatremia na-eme, nke nwere ike ịga n'ihu na coma na cramps. Growmụaka na-eto n’adịghị mma ma na-aba oke ibu, ha na-enwe ọfụma mgbe ha na-eri nri, enweghị agụụ, ọnọdụ hypotonic, afọ ntachi, nchegharị nke uche. Ọkụ ọgbụgba na-asọ oyi ma na-apụta naanị n'ihe banyere enweghị mmiri mmiri.

Nnyocha anụ ahụ:
Na nyocha, enwere ike ịchọpụta ihe mgbaàmà nke akpịrị ịkpọ nkụ: akpụkpọ akpọnwụ na akpụkpọ ahụ mucous. Systolic ọbara mgbali bụ nke nkịtị ma ọ bụ belata mbelata, ọbara diastolic na-abawanye.

Nnyocha ụlọ nyocha:
Dika nyocha nke mmamịrị na-esite, a na-agba ya mmiri, enweghị ihe ọ bụla a na-ahụ maka ọrịa, yana ịdị ala dị ala (1,000-1,005).
Iji chọpụta ike ịta akụrụ, a na-eme nnwale dịka Zimnitsky si kwuo. Ọ bụrụ n’ akụkụ ọ bụla, ike mmamịrị dị elu karịa 1.010, mgbe ahụ enwere ike wepu nchoputa nke ND, n’agbanyeghi, ekwesiri icheta na ọnụnọ shuga na protein dị na mmamịrị na-eme ka mmamịrị ahụ pụta ìhè.
Plasma hyperosmolality karịrị 300mmol / n'arọ. Dị ka ọ na-adịkarị, plasma osmolality bụ 280-290 mosmol / kg.
Hypoosmolality nke mmamịrị (erughi 300mmol / n'arọ).
Hypernatremia (karịa 155 meq / l).
Site n'ụdị Central nke ND, a na-ahụta mbelata nke ọkwa vasopressin n'ọbara ọbara, yana n'ụdị nephrogenic, ọ bụ ihe dị otú o kwesịrị ma ọ bụ nke dị ntakịrị.
Nnwale akpịrị ịkpọ nkụ (nwalee na-eri nri). G.I. Protocol ọnwụ friji Robertson (2001).
Na -akpọ mmiri mmiri:
- were obara maka osmolality na sodium (1)
- na - anakọta mmamịrị iji chọpụta olu na osmolality (2)
- tụọ ịdị arọ nke onye ọrịa (3)
- njikwa ọbara mgbali elu na obi gị (4)
Nke a, n'obere oge nke oge, dabere n'ọnọdụ onye ọrịa, kwugharị usoro 1-4 mgbe awa 1 ma ọ bụ 2 gachara.
A naghị anabata onye ọrịa ị drinkụ mmiri, ọ dịkwa mma ịmachi nri, ọ dịkarịa ala n'oge awa asatọ mbụ nke ule ahụ. Mgbe ị na-enye nri ahụ ekwesịghị ịnwe ọtụtụ mmiri na nri carbohydrates dị mfe, àkwá e ghere eghe, achịcha ọka, obere anụ, azụ.
Ihe nlele ahụ na-akwụsị mgbe:
- mfu ihe kariri 5% nke ahu
- akpịrị ịkpọ nkụ na-agaghị edili
- ezi ọnọdụ nke onye ọrịa
- mmụba nke sodium na osmolality ọbara karịa oke kwesịrị.

Nnwale Desmopressin. A na-eme nnwale ahụ ozugbo ngwụsị nke ule mmiri, mgbe enwere ike ịnweta ihe nzuzo / ihe nke vasopressin endogenous. A na-enye onye ọrịa 0.1 mg nke desmopressin mbadamba ụrọ n'okpuru ire ya ruo mgbe resorption zuru ezu ma ọ bụ 10 μg intranasally n'ụdị ịgba. A na-atụle osmolality ure na tupu desmopressin na elekere 2 na 4 mgbe ọ gachara. N’oge nnwale ahụ, a na-ahapụ onye ọrịa ị drinkụ ihe ọ butụ ,ụ, ma ọ bụghị ihe kariri ugboro 1.5 olu mmamịrị na-ewepụta ya, na ule mmiri.
Deskọwapụta nsonaazụ nnwale ahụ na desmopressin: didị polydipsia nkịtị ma ọ bụ nke izizi na-ebute mkpokọta mmamịrị karịa 600-700 anwụnta / kg, osmolality ọbara na sodium na-adịgide n'ime oke kwesịrị, ọdịmma anaghị agbanwe oke. Desmopressin ihe fọrọ nke nta ka ọ ghara ime ka mmamịrị ahụ bamie ike, ebe ọ bụ na etinyere ọkwa ya kachasị.
Site na etiti etiti, osmolality mmamịrị n'oge akpịrị mmiri anaghị agafe osmolality ọbara ma nọgide na-erughị 300mmol / n'arọ, ọbara na sodium osmolality mụbara, akpịrị ịkpọ nkụ, akpụkpọ ahụ mucous akọrọ, mụbaa ma ọ bụ mbelata ọbara mgbali, tachycardia. Site na ntinye nke desmopressin, osmolality mmamịrị na-abawanye karịa 50%. Site na nephrogenic ND, osmolality ọbara na sodium na-abawanye, osmolality nke mmamịrị erughị 300 mosmol / kg dị ka nke Central ND, mana mgbe iji desmopressin, osmolality nke mmamịrị na-eme ka ọ ghara abawanye (mmụba nke 50%).
Achịkọtara nsonaazụ nsonaazụ nke ndị nlele ahụ na tab. .

Nnyocha nyocha:
A na-ahụta Central Central dị ka akara nke pathology nke mpaghara hypothalamic-pituitary. RIbụrụ MRI bụ usoro nke ịhọrọ n'ịchọpụta ọrịa nke mpaghara hypothalamic-pituitary. Site na etiti etiti ND, usoro a nwere ọtụtụ uru karịa CT na ụzọ onyonyo ndị ọzọ.
A na-eji Brain MRI mee ihe iji chọpụta ihe kpatara Central Central (etuto ahụ, ọrịa infiltrative, ọrịa granulomatous nke hypothalamus na pituitary gland, wdg) N'ihe banyere inphọsis ọrịa nephrogenic: nnwale siri ike nke steeti ọrụ akụrụngwa na ultrasound nke akụrụ Na enweghị mgbanwe mgbanwe ọrịa dịka MRI si kwuo, a na-atụ aro ọmụmụ a. na mgbanwe, ebe enwere otutu mgbe Central ND putara n’afọ ole na ole tutu ahuru na ogwu

Ihe ngosi maka ndụmọdụ ọkachamara:
Ọ bụrụ na a na-enyo mgbanwe mgbanwe akwara na mpaghara hypothalamic-pituitary, a na-egosipụta nyocha nke neurosurgeon na dọkịta na-ahụ maka ọrịa anya. Y’oburu na achoputala oria nke urinary - urologist, na mgbe ikwenye na psychogenic variant nke polydipsia, inwe mkparita uka na ndi dibia ma obu ndi nechochiatrist.

Synthesis na zoro ezo nke homonụ antidiuretic

A na - akpụkọta homonụ antidiuretic vasopressin na supraoptic na paraventricular nuclei nke hypothalamus. Ingkpọtụrụ neurophysin, a na-ebugharị ihe dị mgbagwoju anya n'ụdị granules gaa na njedebe nke mgbakwunye nke axons nke neurohypophysis na mgbatị elu. Na axon na-ejedebe na capillaries, ìgwè ADH na-eme. Ihe nzuzo ADH dabere na osmolality plasma, na-ekesa olu ọbara na ọbara mgbali. Mkpụrụ ndụ akụrụngwa na - arụ ọrụ nke dị n’akụkụ akụkụ ventricular nke akụkụ hypothalamus na - emeghachi omume n ’ụgbanwe ụrọ electrolyte ọbara. Ọrụ osoroceptors na-abawanye na mmụba osmolality ọbara na-akpali akwara vasopressinergic neurons, site na nsọtụ nke a na-ahapụ vasopressin n'ime n'ọbara niile. N'okpuru ọnọdụ physiological, plasma osmolality dị na 282-300 mOsm / kg. Nọmalị, ọnụ ụzọ maka nzuzo nke ADH bụ osmolality ọbara plasma nke malitere na 280 mOsm / kg. A pụrụ ịhụ ụkpụrụ dị ala maka izochi ọrịa ADH n'oge afọ ime, ọrịa uche, na ọrịa oncological. Osmolality plasma mbelata nke mmiri riri oke na - egbochi ọgwụ ADH. Site na ọkwa plasma osmolality karịa 295 mOsm / n'arọ, a na-achọpụta mmụba na nzuzo nke ADH na ịgbalite etiti akpịrị ịkpọ nkụ. Ebe a na-eme ka akpịrị ịkpọ nkụ na ADH na-arụ ọrụ, nke osmoreceptors nke vaskụla olu nke akụkụ nke hypothalamus na-achịkwa, na-egbochi akpịrị nke ahụ.

Iwu nke vasopressin zoro ezo dabere na mgbanwe nha olu. Site n'ọbara, volumoreceptors dị na atrium aka ekpe nwere mmetụta dị ukwuu na nzuzo nke vasopressin. N'ime arịa, ọbara ọgbụgba na-arụ ọrụ, nke dị na mkpụrụ ndụ akwara dị mma nke akwara ọbara. Mmetụta vasoconstrictive nke vasopressin n'oge ọbara na-akpata bụ n'ihi mbelata akwara olu nke arịa ahụ, na-egbochi ọdịda nke ọbara mgbali. Site na mbelata ọbara mgbali elu karịa 40%, enwere mmụba na ọkwa ADH, ugboro 100 dị elu karịa ntọala basal ya nke 1, 3. Baroreceptors dị na carotid sinus na akwara aortic na-aza mmụba nke ọbara mgbali, nke na-eduga ná mbelata na nzuzo ADH. Na mgbakwunye, ADH na-etinye aka na nhazi nke hemostasis, njikọ nke prostaglandins, ma na-akwalite mwepụta nke renin.

Ion sodium na mannitol bụ ihe na-akpali akpali nke vasopressin zoro ezo. Urea anaghị emetụta ihe nzuzo nke homonụ ahụ, glucose na-eduga n'ịkwachi ihe nzuzo ya.

Usoro nke mmeghachi nke homonụ antidiuretic

ADH bụ ihe kachasị mkpa na-ahụ maka njigide mmiri ma na-enye homeostasis mmiri na njikọta na homonụ natriuretic hormone, aldosterone na angiotensin II.

Mmetụta physiological bụ isi nke vasopressin bụ iji kpalite reabsorption mmiri na mkpokọta tubules nke renal cortex na medulla megide gradient osmotic.

N'ime mkpụrụ ndụ akwara taliles, ADH na-arụ ọrụ (ụdị 2 vasopressin ndị na-anabata ya), nke dị na isi ala nke mkpụrụ ndụ nke mkpokọta mkpo. Mmekọrịta nke ADH na-eduga n'ịrụ ọrụ nke adenylate cyclase na-emetụta vasopressin na mmụba na mmepụta cyclic adenosine monophosphate (AMP). Cyclic AMP na-arụ ọrụ protein kinase A, bụ nke na-akpali mmekorita nke protein na-edozi mmiri n'ime akpụkpọ ahụ apical nke sel. Nke a na - ebute mbugharị mmiri site na lumen nke mkpokọta mkpokọ n'ime sel na n'ihu: site na nchedo nke ụzọ mmiri ndị dị na isi mmiri ahụ, a na - ebuga mmiri ahụ na oghere nke oghere, wee banye n'ime arịa ọbara. N'ihi ya, etolitewo mmamịrị nwere osmolality dị elu.

Osmotic ịta bụ mkpokọta ịta ihe niile etisasịwo ahụ. Enwere ike ịkọwa ya osmolarity ma tụọ ya na osmol / l ma ọ bụ dịka osmolality na osmol / kg. Ọdịiche dị n'etiti osmolarity na osmolality dabere na usoro iji nweta uru a. Maka osmolarity, nke a bụ usoro ịgbakọ maka ịta elektrolytes nke bụ isi na mmiri nke amụrụ. Usoro maka ịgbakọ osmolarity:

Osmolarity = 2 x + glucose (mmol / l) + urea (mmol / l) + 0.03 x protein dum ().

Osmolality nke plasma, mmamịrị na mmiri mmiri ndị ọzọ bụ osmotic pressure, nke dabere na nha nke ion, glucose na urea, nke ekpebiri site na iji ngwa osmometer. Osmolality erughị osmolarity site na ịdị ukwuu nke oncotic nrụgide.

Site na izo ya ezo na ADH, mmamịrị osmolarity dị elu karịa 300 mOsm / l ma nwee ike ịbawanye na 1200 mOsm / l ma karịa. Site na enwere nkwarụ nke ADH, osmolality mmamịrị nọ n'okpuru 200m / l 4, 5.

Ihe ndi etiological nke oria mmikpo nke etiti

N'ime ihe ndị kachasị akpata mmepe nke LPC, a na-ebunye ụdị ọrịa ọrịa a na-eketa site na ma ọ bụ ụdị ihe nketa. Enwere ike ịchọta ọnụnọ ọrịa a n'ọgbọ dị iche iche ma nwee ike imetụta ọtụtụ ndị otu ezinụlọ, ọ bụ n'ihi mmụba na-eduga mgbanwe na usoro ADH (DIDMOAD syndrome). Mmekpa ahụ akwara ozi na mmepe nke etiti na diencephalon nwekwara ike bụrụ isi ihe kpatara mmepe nke ọrịa ụbụrụ dị ala. Na 50-60% nke ikpe, isi ihe kpatara mgbu dị ala enweghị ike ịkwado - nke a bụ ihe a na-akpọ ọrịa idiopathic insipidus.

N'ime ihe nke abụọ na-eduga na mmepe nke sistemụ akwara etiti, trauma (mkparịta ụka, mmerụ anya anya, mgbaji nke isi okpokoro isi).

Nzụlite nke NSD nke abụọ nwere ike jikọta ya na ọnọdụ mgbe arụ ọrụ transcranial ma ọ bụ transsphenoidal na ngwo ọria nke ụbụrụ dịka craniopharyngioma, pineloma, germinoma, na-eduga na mkpakọ na mmebi nke polarior pituitary gland.

Mgbanwe ume ọkụ na hypothalamus, supraopticohypophysial tract, funnel, ụkwụ, posterior pituitary gland bụkwa ihe ndị ọzọ na-akpata mmepe nke nrụgide dị ala.

Isi ihe na-ebute ọrịa ọrịa nje bụ ọrịa. N'ime ọrịa ndị na-efe efe dị ukwuu, flu, encephalitis, meningitis, tonsillitis, fever na-acha uhie uhie, ụkwara nta na-ahụkarị, n'etiti ọrịa na-efe efe - ụkwara nta, brucellosis, syndrome, ịba, ọrịa rheumatism 9, 10.

N'ime ihe ndị na - akpata akwara na - akpata dysplasia ihe na - adịghị ala ala bụ syki nke Skien, ọbara ọgbụgba na - akpata akwara neuropoposis, thrombosis, na aneurysm.

Dabere na ọnọdụ mmewere ahụ, LPC nwere ike ịdịgide ma ọ bụ nwee oge. Site na mmebi nke akwara supraoptik na paraventricular nuclei, ọrụ ADH adịghị agbake.

Mmepe nke nephrogenic ND dabere na ihe nnabata ma ọ bụ nsogbu enzymatic nke nsị nke akụrụ, na-eduga na nguzogide nke ndị na-anabata ndị ọrụ na ADH. N'okwu a, ọdịnaya nke ADH endogenous nwere ike ịbụ nke dị elu ma ọ bụ dị elu, ma iwere ADH anaghị ekpochapụ akara nke ọrịa ahụ. Nephrogenic ND nwere ike ibute na ọrịa ogologo oge nke ọrịa urinary, urolithiasis (ICD), na prostate adenoma.

Symptomatic nephrogenic ND nwere ike ịmalite n’ọrịa yana mmebi nke akwara akwara dị ka anaemia, sarcoidosis, amyloidosis. Na ọnọdụ nke hypercalcemia, uche nke ADH na-ebelata ma nwughari mmiri na-agbada.

Ọkpụkpụ mmụọ nke akwaraike na-etolite na sistemụ akwara ozi ọkachasị n’ebe ụmụ nwanyị na - eto eto nọ (Isiokwu 1). Isi ihe mere akpịrị kpọrọ nkụ bụ ọrịa na-akpata nsogbu n'etiti akpịrị ịkpọ nkụ. N'okpuru ike nke nnukwu mmiri na-abawanye na olu nke plasma na-ekesa, mbelata nke nzuzo ADH na-apụta site na usoro baroreceptor. Nnyocha gbasara urinal dị ka Zimnitsky dị na ndị ọrịa a na-ekpughere mbelata na ịdị nro, ebe mkpokọta sodium na osmolarity nke ọbara na-adịgide ma ọ bụ belata. Mgbe a na-egbochi mmiri ị ,ụ mmiri, ọdịmma ndị ọrịa na-anọgide na-eju afọ, ebe uru mmamịrị na-ebelata, ogo ya na-erutekwa ogo ahụ.

Foto onyonyo a na-ahuta bukwanu nke oria di n’ime insipidus

Maka ngosipụta nke ND, ọ dị mkpa iji belata ikike nzuzo nke neurohypophysis site na 85% 2, 8.

Ihe mgbaàmà isi nke ND bụ oke urin na oke akpịrị. Ọtụtụ mgbe olu mmamịrị karịrị 5 lita, ọ nwere ike iru 8-10 lita kwa ụbọchị.

Hyperosmolarity nke plasma ọbara na-akpali etiti akpịrị ịkpọ nkụ. Onye ọrịa ahụ enweghị ike ime na-ejighị mmiri mmiri ihe karịrị nkeji iri atọ. Onu ogugu nke oria jiri udiri oria a karie ihe omuma 3-5, ya na ogba oso - 5-8 lita, nwere udiri - 10 lita ma obu karia. Amịpụrụ eriri afọ, ọnụọgụ ya dị na 1000-1003. N’ime ọnọdụ ị excessiveụ mmiri dị ukwuu n’ime ndị ọrịa, agụụ na-ebelata, afọ na-agbatị, mmiri ga-agbada, eriri afọ na-agbadata, afọ ntachi na-amalite. Mgbe mpaghara hypothalamic metụtara mkpamkpa ma ọ bụ usoro mkpaghasị, yana ND, enwere ike ịhụ nsogbu ndị ọzọ, dịka oke ibu, ọrịa ahụ, galactorrhea, hypothyroidism, ọrịa shuga mellitus (DM) 3, 5. Site na ọganihu nke ọrịa, akpịrị ịkpọ nkụ na-eduga akpụkpọ akpọnwụ na mucous membranes, na mbelata nke mmiri. - na ịchafụ, mmepe nke stomatitis na nasopharyngitis. Site na akpịrị kpọrọ nkụ nke ukwuu, adịghị ike nke izugbe, mkpịsị nke palpitation na-amalite ịba ụba, a na-ahụta mbelata ọbara mgbali elu, isi ọwụwa na-akawanye ngwa ngwa, ọgbụgba na-apụta. Ndị ọrịa na-ewe iwe, enwere ike ịnwe ngbagha, inwe nkwarụ, steeti kọfịktọs.