Matenda a shuga a insipidus: Zizindikiro, chithandizo, zimayambitsa, zizindikiro

Matenda a insipidus ndi matenda omwe amadziwika ndi polyuria yayikulu chifukwa cha kulephera kwa impso kukhazikika mkodzo chifukwa cha kuchepa kapena chifukwa cha kufooka kwa ADH.

Kutsika kwa chobisalira kapena zochita za ADH kumayendetsedwa ndi kuwonjezeka kwa kutuluka kwa madzimadzi (ND), chomwe ndi chifukwa chachikulu cha matendawa.

Matenda a shuga a insipidus (ND) ndi mkhalidwe wa m'magazi momwe mkodzo wambiri womwe umasungunuka komanso wa hypotonic umatayika.

Zoyambitsa matenda a shuga insipidus

Malo oyamba mwa anthu akuluakulu ndi ovulala a craniocerebral komanso kulowererapo kwa mitsempha, muubwana wa CNS chotupa predominate (craniopharyngioma, germinoma, glioma, pituitary adenoma). Zomwe zimayambitsa zimatha kukhala metastases ya zilonda zam'mimba zotupa, zotupa za mtima (zotupa zam'mimba, zotupa, aneurysms), zotupa zophatikizika (hertiocytosis, chifuwa chachikulu, sarcoidosis), matenda opatsirana (toxoplasmosis, cytomegalovirus matenda, meningitis, encephalitis). Vuto la autoimmune la neurohypophysis mu mawonekedwe a lymphocytic infundulenihypophysitis ndi losowa.

Pafupifupi 5% ya odwala ali ndi mtundu wa neurogenic shuga insipidus wokhala ndi cholowa chachikulu cha Autosomal. Matendawa amayamba chifukwa cha masinthidwe a vasopressin precursor gene, prepropressophysin, omwe ali pa chromosome ya 20.

Insipidus yapakati pa matenda a shuga kale imawonedwa ngati chinthu chofunikira cha DIDMOAD syndrome, kapena Tungsten syndrome. Malinga ndi deta yamakono, nthenda yachilendo kwambiri iyi imachitika chifukwa cha kusintha kwa majini a WFS1 pa 4 chromosome yolembera transmembrane protein tungstamine, yomwe imakhudzidwa ndi kayendedwe ka calcium ion mu endoplasmic network ya neurons ndi β-cell of pancreatic islets. Zizindikiro zake zazikulu ndimatenda omwe amadalira insulin komanso kuchepa kwa masomphenya. Zowonongeka zamkati wamanjenje, kuphatikiza matenda a shuga a insipidus, zimayamba pambuyo pake (zaka 20-30) osati mwa odwala onse.

Kugonjetsedwa kwa dera la hypothalamic-pituitary ndi chitukuko cha matenda a shuga insipidus nthawi zina kumatha kuonedwa ndi matenda achilengedwe monga Lawrence-Moon-Barde-Beadle syndrome (kufupika, kunenepa, kuperewera kwa malingaliro, kusokonezeka kwamtundu wa retinal, polydactyly, hypogonadism ndi urogenital anomalies) Hesxl cholembera chinthu.

Matenda a shuga a Gestagenic amawonekera nthawi yapakati. Pankhaniyi, placenta imakulitsa kusweka kwa ADH, ndikupanga enzyme cysteine ​​aminopeptidase, yomwe imapangidwa kuti iwononge oxytocin, komanso imawonongeranso vasopressin.

Nephrogenic shuga insipidus mu mawonekedwe ake ochulukitsidwa sakhala wamba hypothalamic-pituitary. Congenital nephrogenic shuga insipidus ndimatenda osowa kwambiri omwe amayamba chifukwa cha kusagwirizana ndi ADH. Fomu yolumikizira ya X yolumikizidwa, yomwe imayambitsidwa ndi kusintha kwa majini a vasopressin a 2 receptor, imakhala yokhayokha, komanso kupatsirana kwa autosomal komanso kusintha kosintha kwa majini a aquaporin-2 gene (transmembrane ngalande yamadzimadzi yotulutsa ma cell a epuctlial.

Odwala a nephrogenic shuga a insipidus amadziwonetsera nthawi zambiri kuposa kubereka, koma amadziwika ndi chithunzi chosawoneka bwino chachipatala komanso kusinthika kwa zovuta. Zomwe zimayambitsa nthawi zambiri kuposa zina ndi kukonzekera kwa lifiyamu, komwe kumatha kusokoneza kufalitsa kwa ma intracellular kuchokera ku vasopressin receptors. Gentamicin, metacyclin, isophosphamide, colchicine, vinblastine tolazamide, phenytoin, norepinephrine (norepinephrine), loop ndi osmotic diuretics ali ndi vuto lofananalo ndi ntchito yayitali komanso yayitali. Zambiri za matenda a nephrogenic shuga amatha kuonera vuto la electrolyte (hypokalemia, hypercalcemia), matenda a impso (pyelonephritis, tubulo-interstitial nephritis, polycystic, postobstbuilding uropathy), amyloidosis, myeloma, odwala matenda am'mimba komanso sarcoidosis.

Pathogenesis wa matenda a shuga insipidus

Kubisika kwa vasopressin kumayendetsedwa ndi anterior hypothalamus osmoreceptors, omwe amayankha kusinthasintha kwa osmolality kosakwana 1% ya zoyambirira. Kutayika kwa madzi achilengedwe (mkodzo ndi thukuta, kupuma) kumawonjezera pang'onopang'ono mu osmolality ya madzi am'magazi. Ndi kuchuluka kwake mpaka 282–285 mosm / kg, secretion ya vasopressin imayamba kuchuluka. Kuchuluka kwa madzi am'madzi komanso kuchepa kwa madzi a m'magazi, mosiyana,, kumalepheretsa kubisala kwa ADH, komwe kumapangitsa kutsika kwakukulu kwa kubwezeretsanso kwamadzi komanso kuwonjezeka kwamkodzo.

Pakati (neurohypophysial) matenda a shuga insipidus

Pakatikati ya ND, hypotonic polyuria imawonedwa chifukwa cha kuperewera kwathunthu kapena kachiberekero katulutsidwe ka ADH, ngakhale kusangalatsidwa kokwanira kwa kubisalira komanso kuyankha kwamphupi kwa ADH. Central ND imagawidwa kukhala ma subtypes.

Kutengera kuchuluka kwa kuchepa kwa ADH:

• ND yapakati imadziwika ndi kulephera kwathunthu kupangira ADH,
• ND yosakwanira yapakati imadziwika ndi kusakwanira kaphatikizidwe kapena kubisalira kwa ADH.

Kutengera cholowa:

• central chap ND ndi njira yachilendo, yobadwa ndi mtundu wodziwika bwino kwambiri wamatenda osiyanasiyana ndipo umakula muubwana, zolakwika zambiri za chibadwa zimagwirizanitsidwa ndi kusinthidwa kwa kapangidwe ka molekyulu ya neurophysin, yomwe mwina imasokoneza kayendedwe ka intracellular prohormone,
• tenga ND yapakati imayamba chifukwa cha zifukwa zingapo.

Zomwe zimayambitsa matenda ashuga apakati

ND yoyambirira (simunatenge)

ND ND yachiwiri (yotenga)

Nephrogenic shuga insipidus

Amadziwika ndi pafupipafupi hypotonic polyuria, ngakhale ali ndi mulingo wokwanira wa ADH, ndipo kuyang'anira exo native ADH sikukhudza mwina kuchuluka kwa mkodzo wofutukuka kapena osmolarity. Nephrogenic ND imagawidwa kukhala ma subtypes.

Kutengera kuchuluka kwa kuchepa kwa ADH.

• ND yathunthu ya nephrogenic imadziwika ndi kulephera kwathunthu kuyankha kwa vasopressin ngakhale mu Mlingo wa pharmacological.
• ND yosakwanira nephrogenic imadziwika ndi kuthekera kothana ndi pharmacological Mlingo wa vasopressin.

Kutengera cholowa.

• Neredrogen nephrogenic ND imachitika chifukwa cha masinthidwe osiyanasiyana m'malo osiyanasiyana. Mu 90% ya milandu, kusintha kumeneku kumayambitsa kuphwanya kwa ntchito ya vasopressin V₂cholandilira cha impso chubu. Njira ya cholowa X yolumikizidwa, yopumira, ya mkazi yotupa yokhala ndi heterozygous ikhoza kukhala ndi zizindikiro zakuchepa kwamadzi kagayidwe kokhala ndi nocturia, noctidipsy komanso kukoka kwamkati kwamkodzo. Mu 10% ya mabanja okhala ndi cholowa ND, kusintha kwamtundu kumapezeka mu genaporin-2 gene yomwe ili pa chromosome 12, dera q13. Cholowa chamtunduwu chimatha kukhala chosinthika komanso champhamvu kwambiri.
• Wopezeka ND amapezeka nthawi zambiri chifukwa cha hyperkalemia kapena hypercalcemia. M'magawo onse awiriwa, ntchito ya aquaporin-2 mu impso imapanikizika. Lithium imachitanso chimodzimodzi. Kulephera kwa impso ndi kwamikodzo thirakiti kungakhale kovuta chifukwa cha kukula kwa nephrogenic ND.

Zifukwa Zopezera Nephrogenic ND

Polydipsia yoyamba

Ndi polydipsia yoyamba, kudya kwamadzimadzi kumayamba kuchuluka, komwe kumatha kutchedwa "kuzunza" kwamadzimadzi, omwe amayamba kale kuyenda ndi polyuria ndi kuchepa kwa magazi osmolality. Ma polydipsia oyambilira amagawidwa m'mitundu iwiri.

• Dipsogenic ND, momwe gawo la osmotic lolimbikitsira chitetezo cha ADH limasungidwira pamlingo wokhazikika, pomwe gawo losafunikira lachiwopsezo la ludzu limayamba. Kuphwanya kumeneku kumabweretsa hypotonic polydipsia mosalekeza, popeza seramu osmolarity imasungidwa pansipa yopunthwitsa ya secretion ya ADH.
• Psychogenic polydipsia, momwe mumakhala madzi ochulukirapo a paroxysmal, omwe amachititsa kuti pakhale zamavuto amisala kapena matenda amisala. Mosiyana ndi dipsogenic ND, pazinthu izi palibe kuchepa kwa gawo la osmotic kuti lilimbikitse ludzu.

Zizindikiro ndi matenda a shuga insipidus

Monga tafotokozera, zizindikiro zazikulu za matenda a shuga insipidus ndi ludzu, polyuria ndi polydipsia (mosasamala nthawi ya tsiku). Nthawi zambiri odwala amakonda kumwa madzi ozizira kapena zakumwa zoziziritsa kukhosi. Ludzu lausiku ndi polyuria zimasokoneza tulo, ndipo ntchito zamaganizidwe ndi ntchito zamaganizidwe zimachepa. Kugwiritsa ntchito madzi ambiri pang'onopang'ono kumapangitsa kuti m'mimba muzikhala kuchepa komanso kutsekeka kwa chinsisi chake, kusokonekera kwa m'mimba motility.

M'zaka zoyambira matenda a shuga insipidus atha kukhala aliwonse, pomwe mitundu yake yobadwa nayo imakhala ndi mitundu ina.

Matenda a shuga insipidus

Kudziwa zomwe zimayambitsa polyuria nthawi zambiri sizibweretsa mavuto ena, koma nthawi zina zimakhala ntchito yovuta. Chifukwa chake, kupezeka kwa shuga kwa wodwala wokhala ndi polyuria kumawonetsa bwino zomwe zimayambitsa. Kukhalapo kwa matenda amisala mwa wodwala kuphatikiza ndi hypotonic polyuria kumaonetsa polydipsia yoyamba (psychogenic). Kumbali inayo, hypotonic polyuria motsutsana ndi maziko a kuchuluka kwa plasma osmolarity ndi seramu sodium yayikulu sazindikira kupezeka kwa polydipsia yoyamba. Polyuria ikachitika atachitidwa opaleshoni kapena kuvulala kwambiri m'dera la hypothalamic-pituitary, kudziwika kuti ND yapakati ndikudziwikiratu. Pazinthu zosadziwika, mayeso apadera ndi abwino.

Pambuyo pakuchita opaleshoni m'chigawo cha hypothalamic-pituitary kapena kuvulala kwake, kuphwanya kwamadzi kwamadzi nthawi zambiri kumachitika m'magawo atatu.

• Gawo loyamba la ND chosakhalitsa limalumikizidwa ndi axonal shock ndi kulephera kwa maselo am'mitsempha kuti apange kuchitapo kanthu. Imadziwoneka yokha mu maola 24 oyambirira pambuyo povulala ndikusintha m'masiku ochepa.
• Gawo lachiwiri likuwonetsedwa ndi ADH hypersecretion syndrome, limachitika patadutsa masiku 5-7 pambuyo povulala ndipo limalumikizidwa ndi kutulutsidwa kwa ADH kuchokera ku maselo amitsempha akupanga ADH yomwe imawonongeka chifukwa chazovuta (trophic kusokoneza, hemorrhage).
• Gawo lachitatu ndikupanga kwapakati pa ND, pomwe maselo opitilira 90% omwe amapanga ADH awonongedwa ndi zoopsa.

Mwachidziwikire, mphamvu zomwe tafotokozazi za magawo atatu sizimawoneka mwa odwala onse - mwa odwala ena gawo loyamba lokha limatha, mwa ena - woyamba ndi wachiwiri, ndipo mwa odwala ena, kuvulala kwa ubongo kumatha ndi ND yapakati.

Mfundo yodziwitsa za ND yapakati imachepetsedwa kupatula zina zonse zomwe zimayambitsa ND. Makamaka, kuchepa kwa kuchuluka kwa mkodzo wotengedwa ndi vasopressin sikumatsimikizira kuti matenda apakati a ND, chifukwa izi zimachitika polydipsia yoyamba, mwa odwala atachitidwa opaleshoni yaubongo, komanso mwa odwala omwe ali ndi vuto lamadzi, kumapeto kwake, kusungidwa kwa madzi kumatha ngakhale. kuledzera kwamadzi. Kuphatikizidwa kwina kwa chapakati ND ndi kuphatikiza kwa hypotonic polyuria motsutsana ndi magazi osakhazikika kapena osakwezeka pang'ono a magazi a ADH m'magazi. Mosiyana ndi polydipsia yoyamba, momwe simumakhala magazi ochulukirapo, ndipo nthawi zina imachepetsedwa.

Kuyesedwa kwa madzi

Mukamayesedwa ndi kuletsa kwamadzi, kumwa osati madzi okha, komanso madzi ena aliwonse samaikidwa kuti apangitse kuchepa kwa madzi m'thupi ndipo potero amapanga mphamvu yolimbikitsira yokwanira ya ADH. Kutalika kochepetsa kuchepa kwamadzi kumadalira kuchuluka kwa kuchepa kwamadzi ndi thupi, ndipo nthawi zambiri kuyeserako kumatenga maola 4 mpaka 18. Ndikofunikira kuyeserera mchipinda momwe mulibe madzi. Asanayambe kuyesedwa, wodwalayo ayenera kukodza, pambuyo pake ayenera kulemera. Kuyambira pano, thupi la wodwalayo limayang'aniridwa ola lililonse, kuchuluka kwa mkodzo komwe amalembedwa, ndipo mkodzo wa mkodzo umatsimikiziridwa ola limodzi. Kuyesedwa kumathetsedwa mu milandu yotsatirayi:

• Kuchepetsa thupi kunafika 3%,
• wodwalayo adawonetsa zizindikiro za kusakhazikika kwa kayendedwe ka mtima,
• mkodzo osmolarity okhazikika (kusinthasintha kwa osmolarity m'magawo atatu motsatizana kwa mkodzo sikudutsa 30 mOsm / kg),
• Hypernatremia yapangidwa (kupitirira 145 mmol / l).

Momwe osmolarity wakhazikika kapena wodwala atataya thupi loposa 2%, kuyezetsa magazi kotsatira kumachitika:

• zinthu za sodium
• osmolarity
• vasopressin ndende.

Pambuyo pake, wodwalayo amapaka jekeseni wa arginine-vasopressiner (maunitsi asanu) kapena desmopressin (1 mg) mosadukiza, ndipo mkodzo wa osmolarity ndi voliyumu yake amawunikira mphindi 30, 60 ndi 120 pambuyo pa kubayidwa. Mtengo wapamwamba kwambiri wa osmolarity (nsonga) umagwiritsidwa ntchito poyesa kuyankha kumayendedwe a arginine-vasopressinar. Kuti mokwanira mayeso, kuphunzira zamasamba a plasma ndikofunikira pachiyeso, ndiye musanayambike arginine-vasopressin kapena desmopressin ndi pambuyo pa mankhwala.

Odwala omwe ali ndi vuto lalikulu la polyuria (kupitilira 10 l / tsiku), ndikofunikira kuti ayambe kuyesa pamimba yopanda kanthu m'mawa, ndipo amachitika poyang'anitsitsa momwe wodwalayo alili ndi ogwira ntchito kuchipatala. Ngati polyuria ili yodziwika, ndiye kuti kuyesa kungayambike kuchokera maola 22, monga kuletsa kwa madzi kwa maola 12-18 kungafunike.

Tisanayesedwe, ngati zingatheke, mankhwala omwe amakhudza kaphatikizidwe ndi katemera wa ADH amayenera kusiyidwa. Zakumwa zoledzeretsa, komanso mowa ndi kusuta, zimathetsedwa osachepera maola 24 mayeso asanakwane. Pa kuyesedwa, ndikofunikira kuyang'anira wodwalayo mosamala, makamaka mawonetseredwe azizindikiro omwe angalimbikitse kubisala kwa vasopressin motsutsana ndi maziko abwinobwino osmolarity (mwachitsanzo, nseru, matenda ochepa, kapena kusintha kwa vasovagal).

Zaumoyo. Mwa anthu athanzi, kuletsa kwamadzi kumalimbikitsa kwambiri kutulutsa kwa ADH ndipo kumayambitsa mkodzo waukulu. Zotsatira zake, kuyambitsidwa kwa ADH yowonjezereka kapena mawonekedwe ake sikungachititse kuchuluka kwa osmolarity kopitilira 10% ya mkodzo wokhazikika kale.

Polydipsia yoyamba. Pamene osmolarity a mkodzo sakukwera mpaka kukhala wapamwamba kwambiri kuposa magazi a osmolarity, polydipsia yoyambirira imasiyidwa, pokhapokha ngati madzi omwe abisidwa ndi wodwalayo panthawi yoyesedwa samachotsedweratu. Pankhani iyi yotsiriza, osmolarity wamagazi kapena mkodzo osmolarity amawonjezeka mokwanira panthawi yoyesedwa kwa madzi.Chizindikiro china chosagwirizana ndi njira yoyesera ndi kusiyana pakati pa kusintha kwa thupi ndi kuchepa kwamagetsi amthupi ndi thupi - kuchuluka kwa kuchepa kwa madzi mokhudzana ndi kuchuluka kwa thupi la wodwalayo kuyenera kukhala kofanana pang'ono ndi kuchuluka kwa kuchepa kwa thupi panthawi ya mayeso.

ND yonse. Pazonse zapakati komanso nephrogenic ND, pankhani ya ND yathunthu, osmolarity wa mkodzo sapitilira osmolarity wa plasma kumapeto kwa kuyesedwa ndikuletsa madzi. Malinga ndi momwe makina a arginine-vasopressin kapena desmopressin amathandizira, mitundu iwiriyi ya ND imatha kusiyanitsidwa. Ndi nephrogenic ND, kuwonjezeka pang'ono kwa osmolarity kumatha kuchitika pambuyo pa arginine-vasopressin kapena desmopressin, koma osapitirira 10% yomwe yakwaniritsidwa kumapeto kwa nthawi yamadzi. Ndi chapakati ND, kuyang'anira arginine-vasopressin kumapangitsa kuwonjezeka kwa osmolarity wa oposa 50%.

ND. Odwala omwe ali ndi ND yosakwanira, onse omwe ali pakatikati ndi nephrogenic ND, osmolarity wa mkodzo amatha kupitilira magazi osmolarity kumapeto kwa kuyesedwa ndi kuletsedwa kwa madzi. Nthawi yomweyo, ndi chapakati ND, plasma ADH yotsika kuposa momwe amayembekezeka ndi mulingo wodziwika bwino wa osmolarity, pomwe ndi nephrogenic ND ali okwanira wina ndi mnzake.

Hypertonic Sodium Chloride kulowetsedwa

Njirayi imalola kusiyanitsa chosakwanira ND kuchokera ku polydipsia yoyamba.

Njira ndi Kutanthauzira

Panthawi yoyeserera iyi, njira ya 3% ya sodium chloride imalowetsedwa kudzera pamitsempha pafupifupi 1,5 mg / kg pa ola limodzi ndi theka. / l, motero.

Odwala omwe ali ndi nephrogenic ND kapena polydipsia yapamwamba, kuwonjezeka kwa seramu ADH poyankha kuwonjezeka kwa osmolarity kudzakhala kwabwinobwino, ndipo mwa odwala omwe ali ndi chapakati ND, kuwonjezeka kwapadera kwa chitetezo cha ADH kwalembedwa kapena kulibe konse.

Njira yoyeserera

Njirayi imalola kusiyanitsa chapakati chosakwanira ND kuchokera ku nephrogenic ND yosakwanira.

Njira ndi Kutanthauzira

Gawani mankhwala a desmopressin kwa masiku atatu. Chithandizo ichi chimathetsa kapena kuchepetsa mawonekedwe a ND apakati ndipo sichikhudza njira ya nephrogenic ND. Mu polydipsia ya pulayimale, kuyesedwa kwa mayesero sakukhudzidwa ndi madzi, ngakhale nthawi zina ndi ND yapakati, wodwalayo amatha kupitiliza kumwa madzi ochuluka.
Choyamba, muyenera kuwonetsetsa kuti wodwala ali ndi polyuria.

Wodwalayo amapewa kumwa madzi mpaka kuchuluka kwa thupi kumachepera ndi 5% yoyamba kapena ludzu kukhala losapilira. Kwa izi, nthawi zambiri, maola 8 mpaka 12 ndi okwanira .. Mwa anthu athanzi, pamikhalidwe iyi, kutsika kwamkaka pang'onopang'ono ndikuwonjezeka kwa ndulu ndi kuperewera kwamkodzo kwamkati kumachitika, pomwe odwala omwe ali ndi matenda a shuga, kuchuluka kwamkodzo kwamkati sikusintha kwambiri, ndipo osmolity wake sukudutsa 300m / l Kuwonjezeka kwa osmolality wa mkodzo mpaka 750 mosm / l kumawonetsa neurogenic shuga insipidus.

Pozindikira nephrogenic shuga insipidus pamafunika kuunika mozama momwe matenda a impso, kuphatikizidwa kwa kusokonezeka kwa elekitirodi.

Kupeza mbiri yosamalitsa ya mabanja, kupenda abale ake omwe akudwala kumatithandiza kuzindikira ndikusiyanitsa mitundu yobadwa nayo ya matenda a shuga.

Chithandizo cha matenda a shuga insipidus

Madzi okwanira

Odwala omwe ali ndi mawonekedwe ofananawa a ND (diureis ya tsiku ndi tsiku sapitilira 4 l) ndipo makina osungidwa akumva ludzu safunika kupereka mankhwala, ndikokwanira kuti muchepetse kudya kwamadzimadzi.

Kati ND. Lembani analogos vasopressin - desmopressin.

Machitidwe makamaka pa V₂- zomwenso zimakhudzidwa ndi impso₁ vasopressin m'matumbo. Zotsatira zake, mankhwalawa ali ndi kuchepa kwakukulu koopsa ndipo antidiuretic amathandizidwa. Kuphatikiza apo, ali ndi theka la moyo.

Mankhwala akhoza kutumikiridwa 2 kawiri pa tsiku Mlingo wofanana, ndipo mlingo wogwira odwala osiyanasiyana umasiyana mosiyanasiyana.

• pamlomo mlingo wa 100-1000 mcg / tsiku,
• intranasal mlingo wa 10-40 mcg / tsiku,
• subcutaneous / intramuscular / mtsempha wa mtsempha wa 0.1 mpaka 2 mcg / tsiku.

Nephrogenic ND

• Zomwe zimayambitsa matendawa (metabolic kapena mankhwala) zimachotsedwa.
• Mlingo waukulu wa desmopressin nthawi zina umagwira (mwachitsanzo, mpaka 5 mcg intramuscularly).
• Kumwa madzi okwanira.
• Thiazide diuretics ndi ma prostaglandin zoletsa, monga indomethacin, atha kukhala othandiza.

Psychogenic polydipsia ndi yovuta kuchiza ndipo imafunikira chithandizo ndi wamisala.

Ngati matenda ashuga apakati amayamba posagwirizana ndi kusintha kwina komwe kungachitike m'dera la hypothalamic-pituitary, kuyesedwa kuyenera kuthandizira etiotropic (opaleshoni kapena ma radiation ndi chemotherapy ya zotupa, mankhwala othandizira kutupa kwa sarcoidosis, meningitis, ndi zina).

Chithandizo chofanananso ndi matenda a shuga a nephrogenic insipidus sichinapangidwebe. Ngati ndi kotheka, chomwe chimayambitsa matenda omwe mwapeza chikuyenera kuchotsedwa (mwachitsanzo, muchepetse kukonzekera kwa lithiamu). Odwala akuwonetsedwa kubwezeretsa kwamadzi kokwanira, kuletsa mchere.

Kuzindikira kwa matenda ashuga

Matenda a shuga pambuyo pochita opaleshoni yamanjenje ndi kuvulala kwamtundu wamatumbo nthawi zambiri amakhala osachedwa, kuchotsedwa kwapadera kwa mitundu ya idiopathic kumatanthauziridwa.

Kukula kwa odwala omwe ali ndi neurogenic shuga insipidus, monga lamulo, amatsimikiza ndi matenda omwe amayambitsa kuwonongeka kwa hypothalamus kapena neurohypophysis, ndi conenitant adenohypophysis insuffence.