Keywords
Diabetes Insípida
Hidronefrosis
How to Cite
Abstract
La diabetes Mellitus (DM) y la Diabetes insípida (DI) se han asociado en 28 niños, varios de ellos hermanos; al haber atrofia óptica adicional se ha configurado un sindrome hereditario. Ocasionalmente la poliuria de la DI produce dilatación vesical e hidronefrosis. Presentamos un niño de 8 años, con 4 años de evolución de DM, muy glucolábil. Ingresó deshidratado, estuporoso e hipoglicémico. Durante el tratamiento desarrolló marcada polidipsia (se tomaba hasta sus propios orines) y poliuria de 6 a 10 litros en 24 horas con hipourodensidad a pesar de la gran glicosuria. Las glicemias variaron de 26 a 660 mg por ciento, con glicosurias hasta de 23 g/L. Los padres y 3 hermanos eran sanos. Fondo de ojo de retinopatía diabética grado II. Durante la restricción de líquidos persistió la poliuria con hipouroidensidad (1.005) y pérdida de peso: el Pitresín I.M. disminuyo el volumen y aumentó la densidad a 1.026. Una cistouretrografía mostró gran capacidad vesical (450 cc) y reflujo vesical-ureteral; la urografía mostró dilatación del tracto superior, hidronefrosis que fue confirmada por la biopsia renal. La función renal era normal. Convulsionó varias veces e hizo cambios de conducta por hipoglicemias. Se continuó el tratamiento con NPH, dieta y Pitresín, buscando obtener glicemias intermedias.
SUMMARY
Coexistence of Diabetes Mellitus and insipidus with hidronephrosis in a boy
Diabetes Mellitus (DM) and diabetes insipidus (DI) have been found in association in 28 children, some of them being brothers; a hereditary syndrome may also include optic atrophy. Ocasionally, DI polyuria produces bladder dilatation and hydronephrosis. We report the case of a boy, age 8 with brittle DM progressing through 4 years. He was dehydrated, stuporous and hypoglycemic on admission. While on treatment he developed marked polydipsia (he was drinking even his own urine) and polyuria of 6 to 10 liters in 24 hours, with low urine density in spite of large glycosuria (up to 23 g/L). Bood sugars ranged between 26 and 660 mg per cent. Parents and three brothers were living and well. Fundoscopic examination revealed a grade II diabetic retinopathy. During a fluid deprivation test, polyuria with low density (1005) persistent, and patiend lost weight; I.M. Pitressin Tannate oil decreased urine output and raised density to 1026. A Cystourethrography showed a large capacity (450 cc) with vesico-ureteral reflux; intravenous pyelography showed dilation of upper urinary tract, hidronefrosis that was confirmed by kidney biopsy, kidney function was normal; he had grand mal seizures and changes in behavior, due to hypoglicemic attacks, several times. Treatment based on die, NPH insulin and Pitressin was continued, trying to obtain acceptable bloodsugar levels.
* Este trabajo fue presentado en el V Congreso Colombiano de Medicina Interna. Cali, Noviembre de 1978.
References
2. BRETZ, G. W. BAGHDASSARIAN, A. GRABER J. D., ZACHERLE, B. J. NORUM, R. A. BLIZZARD. R. M.: Coexistence of Diabetes Mellitus and insipidus and optic atrophy in two mall siblings: Studies and review of the literature. Am. J. Med. 48: 398-403, 1970.
3. DAMASKE. M. M. COHEN D. N. GUTMAN, F. A., and SCHUMAKER O.P.: Optic atrophy Diabetes Mellitus and Diabetes Insipidus, J. Pediatr Ophtalmol 12:16-21, 1975.
4. NATELSON. R.P.: Case report. Ann Intern Med. 40: 788, 1954.
5. ALLAN. F. N. ROWNTREE. L. G.: The association of diabetes insipidus and diabetes mellitus Endocrinology 15: 97. 1931.
6. CHUTE. A. L. REBLAM.A., BEN. H. W. KRUYFF E.: hypothalamic, pituitary. pancreatic inter-relationships, Xth Congress Internationale de Pediatrie, Lisbonne, p. 226, 1962 (Citado por Bretz y cols.).
7. SCHWARTZ. T. B. RYAN. W. C.: The Yearbook of Endocrinology 1977, Year Medical Publisher, Chicago 1977 pp. 367.
8. CARTER, R. D. GOODMAN A.D.; Nephrogenic diabetes insipidus accompanied by massive dilation of kidneys, ureters and bladder, J Urol 89:366-369, 1963.
9. WHEELER, J. S., ADELSON, W. J.: Pituitary diabetes insipidus associated with progressive urinary tract dilatation. J Urol 92: 64-67, 1964.
10. BENSEL R. W. PETERS E. R.: Progressive hydrohephrosis, hydroureter and dilatation of the blader in siblings with congenital nephrogenic Diabetes Insipidus. J. Pediat 77: 439-43.
11. RAMSEY E.W. MORRIN P.A.F, BRUCE A.W.: Nephrogenic diabetes insipidus associated with massive hydronephrosis and bladder neck obstruction J Urol 111: 225-228, 1974
12. GoSSAN. W. SGAWARA. M. AGEN. G. A.: Co-existent diabetes mellitus and diabetes inspidus, a familial disease. J can endocrino Metab 41: 1020-1024, 1975.
13. ROSE, C, FRAZER. G. R. FRIEDMAN. A. L., KOHNER E. M. The association of juvenil diabetes mellites an optic trophy: clinical and genetical aspects. Quarts J. Med 35: 385, 1966
-- Raiti. S. Poltkin. S. New N.S. G. N.: diabetes Mellitus and insipidus in two sisters, Brit
Med 1: 1625 iss3.
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent. A copy may be reviewed here