Diabetes insipidus refer to a group of disease characterized by the excess production of dilute urine resulting in the need for occasional drinking. Central diabetes insipudus is the most common and is a result of the damage of pituitary gland hence disrupting the average production of ADH ( Robertson, 2016) . In nephrogenic diabetes insipidus, kidneys are unable to respond to ADH. Therefore they are unable to absorb water as required ( Bockenhauer et al., 2015) . Finally, dipsogenic diabetes insipudus comes from a defect in the thirst mechanism of the hypothalamus. This result in strange thirst feeling and excess fluid intake hence suppressing the production of ADH and urine.
Blood tests indicate a low amount of ADH in the case of central diabetes insipudus. In the lab, desmopressin is given. If it reduces urine production, then the diagnosis is central DI. If it does not, then the problem is dipsogenic.
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The transfer of a faulty gene from a parent causes the genetic version of central diabetes insipudus. However, one in five people with central diabetes insipudus is due to surgery ( Cerbone et al., 2018) . Also, a tumor, inflammation, injury or a disease such as tuberculosis also cause the disease. Desmopressins are useful in treating this type. On the other hand, nephorgenic diabetes insipudus is mainly caused by long-term medication such as lithium based drugs ( Bockenhauer et al., 2015) . Kidney failure, sickle cell disease, and polycystic kidney disease also cause the problem. A combination of diuretics and NSAIDS are used to concentrate urine instead of synthetic hormones. Dipsogenic diabetes mellitus is mainly related to behavioral disorders ( Robertson, 2016) . Use of desmopressin is contraindicated in this type as it reduces urine output without reducing thirst and water intake hence the possibility for water toxicity.
Extreme dehydration would is a red flag for both central and nephogenic diabetes insipudus and would require immediate action to save the patient ( Cerbone et al., 2018) . On the other hand, water toxicity is a red flag for dipsogenic diabetes mellitus and require immediate response to reverse adverse consequences.
Case Study
To collect more data on the patient, it is necessary to examine her in full. Among questions, I would ask to include whether she has been experiencing constipation, muscle pains, and depression. Also, questions on whether she has been feeling warm and anxious at times.
In the physical exam, I would look for signs of the skin being dry, hair loss and heart rate. Presence of a rapid heart rate, excessive hair loss or dehydrated skin indicates the patient may be suffering from thyroiditis.
In explaining to the patient about the symptoms she is experiencing, I would dwell on how the problem occurs and the factors related to its development. First, thyroiditis is caused by antibodies attacking the thyroid hence causing it to be inflamed and affecting its functionality ( Argatska et al., 2016) . As the hormone is responsible for the utilization of energy in the body, altered functionality change energy use and hence the effect on weight. For the first six months after birth, there is hyperthyroidism which causes a decline in influence by the individual. Weight loss, rapid heart rate, hair loss, and anxiety are among the common symptoms. However, after sometimes, often from the seventh month, the thyroid function goes abnormally low causing a reverse of these symptoms. Fatigue, weight gain, dry depression skin are among the common symptoms at this stage which is where the patient is at the moment. These are the symptoms that the patient is experiencing at this moment. It is essential to assue the patient that the problems are curable and she will regain her normal stature and health with just a few medications.
References
Argatska, A., Nonchev, B., Orbetzova, M., & Pehlivanov, B. (2016). Postpartum thyroid dysfunction in women with autoimmune thyroiditis. Gynecological Endocrinology , 32 (5), 379-382.
Bockenhauer, D., & Bichet, D. G. (2015). Pathophysiology, diagnosis, and management of nephrogenic diabetes insipidus. Nature Reviews Nephrology , 11 (10), 576.
Cerbone, M., Visser, J., Bulwer, C., Ederies, A., Kamali, I., Grossman, A., ... & Spoudeas, H. A. (2018). G356 Decision making management guideline for patients (< 19 y) with idiopathic thickened pituitary stalk and/or idiopathic central diabetes insipidus.
Robertson, G. L. (2016). Diabetes insipidus: Differential diagnosis and management. Best Practice & Research Clinical Endocrinology & Metabolism , 30 (2), 205-218.
