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Diabetes insipidus
Introduction
- Rare endocrine disorder. Primary nephrogenic diabetes insipidus has not been reported in cat.
- Cause: absolute or relative deficiency of anti-diuretic hormone (ADH).
- 2 forms:
- Hypothalamic-hypophyseal CDI (HDDI).
- Nephrogenic DI (NDI).
- Signs: polyuria/polydipsia; urine: low SG/osmolarity.
- Diagnosis: water deprivation test/response to antidiuretic hormone.
- Treatment: desmopressin (synthetic ADH) Desmopressin.
Presenting signs
- Polyuria (possibly incontinence).
- Extreme polydipsia.
- Other neurological signs or hormonal defects if caused by functional lesions of neurohypophysis.
Acute presentation
- If water intake restricted → dehydration, coma and death.
Age predisposition
- Young adult.
Cost considerations
- Desmopressin treatment is expensive.
Pathogenesis
Etiology
Central form
- Partial or total failure to synthesize or release ADH → idiopathic or secondary, eg head trauma, neoplasia, inflammatory or vascular damage.
Nephrogenic form
- Failure of distal renal tubules to respond to ADH (renal tubule insensitivity).
- Congenital form rare.
- Usually acquired:
- Renal disease, eg medullary or tubular fibrosis Kidney: chronic kidney disease.
- Hyperadrenocorticism Hyperadrenocorticism.
- Diabetes mellitus Diabetes mellitus.
- Hypercalcemia Blood biochemistry: total calcium Hypercalcemia: overview.
- Hypokalemia Blood biochemistry: potassium.
- Hepatic insufficiency Liver: chronic disease.
- Hyperthyroidism Hyperthyroidism.
- Iatrogenic.
- Post-obstructive ureteral diuresis Urethra: obstruction.
Pathophysiology
- Absolute or relative deficiency of ADH → marked polyuria and resultant polydipsia.
- In normal animal only 95% of water reclaimed from Loop of Henle filtrate.
- Destruction of production sites for vasopressin → reduced circulating hormone → membranes of distal tubule impermeable to water and solute → fluid from Loop of Henle excreted unmodified as urine.
Timecourse
- Weeks to months.
- May be years in primary form with no other clinical signs.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Aroch I, Mazaki-Tovi M, Shemesh O et al (2005) Central diabetes insipidus in five cats; clinical presentation, diagnosis and oral desmopressin therapy. J Feline Med Surg 7 (6), 333-339 PubMed.
- Feldhahn J R, Rand J S, Kinnaird E (1999) The effect of interday variation and a short term stressor on insulin sensitivity in clinically normal cats. J Fel Med Surg 1 (4), 233-240 PubMed.
- Feldhahn J R, Rand J S & Martin G (1999) Insulin sensitivity in normal and diabetic cats. J Feline Med Surg 1 (2), 107-15 PubMed.
- Martin G J W, Rand J S (1999) Food intake and blood glucose in normal and diabetic cats fed ad libitum. J Fel Med Surg 1 (4), 241-251 PubMed.
- Rand J (1999) Current understanding of feline diabetes : Part 1. Pathogenesis. J Feline Med Surg 1 (3), 143-53 PubMed.
- Haberer B & Reusch C E (1998) Glycated hemoglobin in various pathological conditions - investigations based on a new, fully automated method. JSAP 39 (11), 510-7 PubMed.
- Kraus K H (1987) The use of desmopressin in the diagnosis and treatment of diabetes insipidus in cats. Comp Cont Ed Pract Vet 9 (7), 752-758 VetMedResource.
- Burnie A G & Dunn J K (1979) A case of central diabetes insipidus in the cat - diagnosis and treatment. JSAP 23 (4), 237-41 VetMedResource.
- Rogers W A, Valdez H & Anderson B C (1977) Partial deficiency of antidiuretic hormone in a cat. JAVMA 170 (5), 545-547 PubMed.