Insipidus ea lefu la tsoekere bohareng - kutlwisiso ea hona joale ea tlhahlobo le kalafo

Lefu la tsoekere (ND) (lefu la tsoekere la sethoathoa sa Latin) - lefu le bakoang ke tlolo ea motsoako, secretion kapa ketso ea vasopressin, e bonts'itsoeng ke thipa ea moroto o moholo o nang le letsoalo le tlase la "hypotonic polyuria", ho omella le lenyora.
Epidemiology. Palo ea ND ka bongata bo fapaneng e tloha ho 0.004% ho isa ho 0,01%. Ho na le mokhoa oa lefats'e o lebisang keketseho ea tšoaetso ea ND, haholo ka lebaka la sebopeho sa eona se bohareng, se amanang le keketseho ea lipalo tsa ts'ebetso ea ts'ebetso e sebelisitsoeng bokong, hammoho le palo ea likotsi tsa craniocerebral, moo maemo a ND a nts'etsopele akhaonto a ka bang 30%. Ho lumeloa hore ND e ama basali ka tsela e tšoanang. Tekanyo ea tlhoro e etsahala ha a le lilemo li 20-30.

Lebitso la Protocol: Lefu la tsoekere

Khoutu (dikhoutu) ho latela ICD-10:
E23.2 - Lefu la tsoekere

Letsatsi la Nts'etsopele ea Protocol: Mmesa 2013

Maele a sebelisitsoeng ho Protocol:
ND - lefu la tsoekere
PP - polydipsia ea mantlha
MRI - monahano oa matla a khoheli
HELL - khatello ea mali
Lefu la tsoekere
Ultrasound - Ultrasound
Phekolo ea ka mpeng
Li-NSAIDs - lithethefatsi tse seng khahlanong le ts'oaetso tsa mali
CMV - cytomegalovirus

Sehlopha sa Bakuli: banna le basali ba lilemo tse 20 ho isa ho tse 30, nalane ea likotsi, ts'ebetso ea methapo ea kutlo, masapo (craniopharyngoma, germinoma, glioma, jj), tšoaetso (tšoaetso ea CMV ea congenital, toxoplasmosis, encephalitis, meningitis).

Basebelisi ba Protocol: ngaka ea tikoloho, endocrinologist ea polyclinic kapa sepetlele, neurosurgeon ea sepetlele, ngaka e fanang ka likotsi tsa bakuli ba sepetlele, ngaka ea bana ba setereke.

Tlhomamiso

Pehelo ea Clinical:
Tse atileng haholo ke:
1. Bohareng (hypothalamic, pituitary), ka lebaka la ho senyeha ha tlhaho le secretion ea vasopressin.
2. Nephrogenic (renal, vasopressin - e hanyetsanang), e khetholloang ka ho hanyetsa liphio ho vasopressin.
3. Polydipsia ea mantlha: bokuli ha lenyora la tlhaho (dipsogenic polydipsia) kapa takatso e qobelloang ea ho noa (psychogenic polydipsia) le tšebeliso e ngata ea metsi e hatella secretion ea mmele ea vasopressin, e hlahisang matšoao a lefu la tsoekere le phello ea lefu la tsoekere. e ntse e nchafatsoa.

Mefuta e meng e sa tloaelehang ea lefu la tsoekere le eona ea khetholoha:
1. Progestogen e amanang le ts'ebetso e eketsehileng ea enzyme ea placenta - arginine aminopeptidase, e senyang vasopressin. Kamora ho tsoala ngoana, boemo boa fetoha.
2. Ts'ebetso: e etsahala ho bana ba selemo sa pele sa bophelo mme e bakoa ke ho se tsitse ha mochine oa khatello ea liphio le ts'ebetso e eketsehileng ea mofuta oa 5 phosphodiesterase, e lebisang ho deactivation e potlakileng ea receptor bakeng sa vasopressin le nako e khuts'oane ea ketso ea vasopressin.
3. Iatrogenic: ts'ebeliso ea li-diuretics.

Classified ea ND ho latela boima ba thupelo:
1. bonolo - moroto ho fihlela ho 6-8 l / letsatsi ntle le kalafo,
2. bohareng - tlhahiso ea moroto ho fihlela 8-14 l / letsatsi ntle le kalafo,
3. boima - urination ea ho feta 14 l / letsatsi ntle le kalafo.

Ts'oaretso ea ND ho latela tekanyo ea matšeliso:
1. matšeliso - kalafo ea lenyora le polyuria u se ke oa khathatseha,
2. subcompensation - nakong ea kalafo ho na le liketsahalo tsa lenyora le polyuria mots'eare,
3. ho bola - lenyora le polyuria li phehella.

Ts'oaetso

Lethathamo la mehato ea mantlha le tlatsetso ea tlhahlobo:
Mehato ea ho hlahloba pele ho sepetlele se reriloeng:
- Tlhahlobo ea moroto ka kakaretso,
- Teko ea biochemical ea mali (potasiamo, sodium, calcium e felletseng, calcium ionized, tsoekere, protheine eohle, urea, creatinine, osmolality ea mali),
- Tlhatlhobo ea diuresis (> 40 ml / kg / letsatsi,> 2l / m2 / letsatsi, osmolality ea morine, letsoalo la setho).

Mehato ea mantlha ea tlhahlobo ea mafu:
- Mohlala oa lijo tse ommeng (tlhahlobo ea ho omella),
- Teko ka desmopressin,
- MRI ea sebaka sa hypothalamic-pituitary

Mehato e meng ea ho khetholla:
- ultrasound ea meno,
- Liteko tsa tšebetso ea meno e matla

Tlhahlobo ea ho hlahloba:
Litletlebo le anamnesis:
Lipontšo tse ka sehloohong tsa ND li hlahisoa ka polyuria (ho tsoa ha moroto ho feta 2 l / m2 ka letsatsi kapa 40 ml / kg ka letsatsi ho bana ba baholo le batho ba baholo), polydipsia (3-18 l / ka letsatsi) le likhathatso tsa boroko tse amanang. Khetho ea metsi a batang / a leqhoa a tsebahala. Ho kanna ha ba le letlalo le omileng le li-membrane tsa mucous, ho fokotseha ha sofa le ho fufuleloa. Takatso ea lijo hangata ea fokotseha. Ho teba ha matšoao ho latela tekanyo ea ho haella ha neurosecretory. Ka bofokoli bo itseng ba vasopressin, matšoao a kliniki a ka 'na a se hlake hantle mme a bonahala maemong a ho nwa kapa ho lahleheloa ke metsi ka bongata. Ha ho bokelloa anamnesis, ho hlokahala ho hlakisa nako le ho phehella ha matšoao ho bakuli, ho ba teng ha matšoao a polydipsia, polyuria, lefu la tsoekere ho beng ka motho, nalane ea likotsi, ts'ebetso ea methapo ea methapo, li-tumors (craniopharyngioma, germinoma, glioma, jj.), Ts'oaetso (ts'oaetso ea CMV , toxoplasmosis, encephalitis, meningitis).
Ho masea le masea, setšoantšo sa lefu lena se fapane haholo le sa batho ba baholo, hobane ba sitoa ho hlahisa takatso ea bona ea ho ja mokelikeli o mongata, o thatafatsang tlhahlobo e tlang ka nako mme se ka lebisa nts'etsong ea tšenyo e ke keng ea fetoloa ea boko. Bakuli ba joalo ba ka ba le boima ba 'mele, letlalo le omeletseng le le boreleli, ho ba sieo ha meokho le mofufutso, le keketseho ea mocheso oa' mele. Li kanna tsa khetha lebese la matsoele ho metsi, 'me ka nako e' ngoe lefu lena le ba le matšoao feela kamora ho khoesoa lesea. Urine osmolality e tlase ebile e ka seoelo e fetang 150-200 mosmol / kg, empa polyuria e hlaha feela maemong a keketseho ea mokelikeli oa bana. Ho bana ba lilemong tsena tsa bocha, hypernatremia le hyperosmolality ea mali ka ho ts'oaroa le ho soahlana hangata le ho hola kapele.
Ho bana ba seng ba holile, lenyora le polyuria li ka hlahella matšoao a tleleniki, ka ho ja lijo tse sa lekanang, menyetla ea hypernatremia e ka tsoelang pele ho fetoha komello le makhopho. Bana ba hola hampe 'me ba nona, ba atisa ho hlatsa ha ba ja, ho hloka takatso ea lijo, maemo a hypotonic, ho sokela, ho khutlisetsoa kelellong. Ho haelloa ke metsi ka botlalo hoa hypertonic ho hlaha feela maemong a ho haella ha metsi.

Tlhahlobo ea 'mele:
Tlhahlobong, ho ka fumanoa matšoao a ho omella: letlalo le omileng le li-membrane tsa mucous. Khatello ea mali ea Systolic e tloaelehile kapa e fokotsehile hanyane, khatello ea mali ea diastolic ea eketseha.

Patlisiso ea laboratori:
Ho latela tshekatsheko e akaretsang ea moroto, e ea bululeloa, ha e na lintho tse amanang le lefu lena, tse nang le letsoalo le tlase (1,000-1,005).
Ho fumana bokhoni ba liphio, tlhahlobo e etsoa ho latela Zimnitsky. Haeba karolong efe kapa efe matla a moroto o itseng a phahame ho feta 1.010, joale tlhahlobo ea ND e ka khelloa ka thoko, leha ho le joalo, ho lokela ho hopoloa hore ho ba teng ha tsoekere le protheine ho moroto ho eketsa matla a khethehileng a moroto.
Plasma hyperosmolality e feta 300 mosmol / kg. Ka tloaelo, osmolality ea plasma ke 280-290 mosmol / kg.
Hypoosmolality ea moroto (ka tlase ho 300 mosmol / kg).
Hypernatremia (ho feta 155 meq / l).
Ka foromo e bohareng ea ND, ho fokotseha hoa boemo ba vasopressin serum ea mali ho lemohuoa, 'me ka foromo ea nephrojene, e tloaelehile kapa e eketsehile hanyane.
Teko ea ho felloa ke metsi (etsa liteko ka ho ja tse omeletseng). Protocol ea Tlhatlhobo ea Metsi Robertson (2001).
Karolo ea ho felloa ke metsi:
- nka mali bakeng sa osmolality le sodium (1)
- bokella moroto ho tseba hore na molumo le maikutlo a hau ke afe (2)
- lekanya boima ba mokuli (3)
- Taolo ea khatello ea mali le sekhahla sa pelo (4)
Kamora nako, ka linako tse lekanang, ho latela boemo ba mokuli, pheta mehato ea 1-4 kamora lihora tse 1 kapa tse peli.
Mokuli ha a lumelloe ho noa, ho boetse ho eletsoa hore a fokotse lijo, bonyane nakong ea tlhahlobo ea lihora tse 8. Ha ho fepa lijo ha hoa lokela ho ba le metsi a mangata le lik'habohaedreite tse bobebe, mahe a belisitsoeng, bohobe ba lijo-thollo, nama e nang le mafura a fokolang, litlhapi li khethoa.
Mohlala oa emisa ha:
tahlehelo ea boima ba 'mele bo fetang 5%
- lenyora le sa mamelleheng
- Boemo bo tebileng ba mokuli
- keketseho ea sodium le mali osmolality ka holim'a meeli e tloaelehileng.

Teko ea Desmopressin. Teko e etsoa hang kamora ho fela ha tlhahlobo ea ho omella, ha monyetla o moholo oa secretion / ketso ea vasopressin ea endo native e fihlelloa. Mokuli o fuoa 0,1 mg ea desmopressin ea litafole tlasa leleme ho fihlela resorption e felletseng kapa 10 μg ka mokhoa oa sesepa. Urine osmolality e lekantsoe pele ho desmopressin le lihora tse 2 le 4 kamora moo. Nakong ea tlhahlobo, mokuli o lumelloa ho noa, empa eseng makhetlo a fetang 1.5 a bophahamo ba moriti oa hae, tlhahlobo ea ho felloa ke metsi.
Tlhaloso ea sephetho sa liteko ka desmopressin: Polydipsia e tloaelehileng kapa ea mantlha e etsa hore mokokotlo oa moroto o be kaholimo ho 600-700 mosmol / kg, osmolality ea mali le sodium e lula maemong a tloaelehileng, boiketlo ha bo fetohe haholo. Desmopressin ha e hlile ha e eketse bokhoni ba ho ntša metsi ka bongata ba moroto, kaha ho se ho fihlile molemong oa khatello ea mantlha.
Ka ND ea bohareng, ho omella ha moroto nakong ea ho omella ha ho fetele ka mali osmolality mme ho lula ho le tlase ho 300 mosmol / kg, mali le sodium osmolality e eketseha, lenyora le tšoailoeng, ho omella ha mucous, ho eketsa kapa ho fokotseha ha khatello ea mali, tachycardia. Ka kenyelletso ea desmopressin, osmolality ea moroto e eketseha ka 50%. Ka nephrogenic ND, osmolality ea mali le ho eketseha ha sodium, osmolality ea moroto e ka tlase ho 300 mosmol / kg joalo ka ND e bohareng, empa kamora ho sebelisa desmopressin, osmolality ea moroto hoo e batlang e sa eketsehe (eketsa ho fihla ho 50%).
Tlhaloso ea sephetho sa sampole e khutsufalitsoe ho tab. .

Patlisiso e kopantsoeng:
ND e bohareng e nkuoa e le lets'oao la methapo ea tikoloho ea hypothalamic-pituitary. Brain MRI ke mokhoa oa khetho oa ho khetholla mafu a sebakeng sa hypothalamic-pituitary. Ka ND ea bohareng, mokhoa ona o na le melemo e 'maloa ho feta CT le mekhoa e meng ea ho nahana.
Brain MRI e sebelisoa ho supa lisosa tsa lefu la ND (tumors, mafu a tšoaetsanoang, mafu a granulomatous a hypothalamus le pituitary gland, jj. Maemong a nephrogenic lefu la tsoekere: liteko tse matla tsa boemo ba ts'ebetso ea renal le ultrasound ea liphio Ha ho se liphetoho tsa pathological ho latela MRI, thuto ena e khothalletsoa ka matla, kaha ho na le maemo a ha ND e bohareng e hlaha lilemo tse 'maloa pele tumello e fumanoa

Matšoao bakeng sa likeletso tsa setsebi:
Haeba liphetoho tsa pathological sebakeng sa hypothalamic-pituitary li belaelloa, ho bonts'oa lipuisano tsa ngaka ea methapo ea kutlo le setsebi sa mahlo. Haeba ts'ebetso ea methapo ea methapo ea methapo e fumaneha - ngaka ea mafu, 'me ha ho netefatsoa phapang ea psychogenic ea polydipsia, ho hlokahala tumellano le ngaka ea mafu a kelello kapa neuropsychiatrist.

Synthesis le secretion ea li-antidiuretic hormone

Vasopressin ea antidiuretic e hlophisitsoe ka har'a tsoekere ea "supraoptic" le "" "" "" "" hypothalamus ". Ho ikopanya le neurophysin, mofuta o rarahaneng ka tsela ea granules o isoa sebakeng sa polokelo ea methapo ea methapo ea methapo ea methapo ea kutlo le mothapo o phahameng. Sebakeng sa axon se kopana le li-capillaries, ho bokelloa ha ADH ho etsahala. Secretion ea ADH e itšetlehile ka osmolality ea plasma, potoloho ea mali le khatello ea mali. Lisele tse sa tsotelleng tsa Osmotically tse fumanehang likarolong tse haufi tsa moea tsa hypothalamus ea anterior li arabela ha ho e-ba le liphetoho sebopeho sa mali sa electrolyte. Ts'ebetso e ntseng e eketseha ea li-osmoreceptors ka keketseho ea osmolality ea mali e matlafatsa li-vasopressinergic neurons, ho tloha lipheletsong tseo vasopressin e ntšoang mali. Tlas'a maemo a mmele, plasma osmolality e maemong a 282-300 mOsm / kg. Ka tloaelo, monyako oa secretion ea ADH ke osmolality ea plasma ea mali ho qala ho tloha 280 mOsm / kg. Litekanyetso tse tlase tsa secretion ea ADH li ka bonoa nakong ea bokhachane, psychoses e mpe le mafu a oncological. Ho theoha ha osmolality ea plasma e bakiloeng ke ho ja ha metsi a mangata ho hatella secretion ea ADH. Ka sekhahla sa plasma osmolality se fetang 295 mOsm / kg, keketseho ea secretion ea ADH le ts'ebetso ea setsi sa lenyora e tsejoa. Setsi se kopantsoeng sa lenyora le ADH, se laoloang ke li-osmoreceptors tsa vascular plexus tsa karolo e ka ntle ea hypothalamus, se thibela ho fokola hoa mmele.

Taolo ea secretion ea vasopressin e boetse e itšetlehile ka liphetoho tsa molumo oa mali. Ka ho tsoa mali, li-volumoreceptors tse fumanehang kahare ea atrium li na le tšusumetso e kholo ho secretion ea vasopressin. Likepeng, khatello ea mali e sebetsa ka har'a lisele tse boreleli tsa methapo ea mali. Matla a vasoconstrictive a vasopressin nakong ea tahlehelo ea mali ke ka lebaka la phokotso ea lera le boreleli la sekepe, se thibelang ho oa ha khatello ea mali. Ka ho fokotseha ha khatello ea mali ka liperesente tse fetang 40, ho na le keketseho ea tekanyo ea ADH, makhetlo a 100 ho feta tekano ea eona ea bas 1, 3. Baroreceptors e fumanehang ho carotid sinus le arch ea arctic e arabela keketseho ea khatello ea mali, eo qetellong e lebisang ho fokotseha ha sechertion ea ADH. Ntle le moo, ADH e kenya letsoho taolong ea hemostasis, sebopeho sa li-prostaglandins, mme e khothaletsa tokollo ea renin.

Li-ion tsa sodium le mannitol ke lintho tse ka u thusang haholo hore u se ke ua etsa letho ka sechetion ea vasopressin. Urea ha e ame secretion ea hormone, 'me tsoekere e lebisa ho thibeng ha eona secretion.

Mochine oa ts'ebetso oa li-hormone tsa antidiuretic

ADH ke molaoli oa bohlokoahali oa ho boloka metsi mme o fana ka mokelikeli oa homeostasis hammoho le atrial natriuretic hormone, aldosterone le angiotensin II.

Phello e ka sehloohong ea 'mele ea vasopressin ke ho hlohlelletsa ho khutlisetsoa ha metsi ka pokellong ea lithane tsa renal cortex le medulla khahlano le khatello ea khatello ea "osmotic"

Ka liseleng tsa renal tubules, ADH e sebetsa ka ho sebelisa (mofuta oa 2 vasopressin receptors), tse fumanehang liseleng tsa basolateral tsa lisele tsa likubu tse bokellang. Ho sebelisana ha ADH ho lebisa ho ts'ebetsong ea cyclase ea adoplatein e tsotellang ea vasopressin le keketseho tlhahiso ea cyclic adenosine monophosphate (AMP). Cyclic AMP e kenya tšebetsong protheine kinase A, eo le eona e eketsang ho kenyelletsoa ha liprotheine tsa methapo ea metsi ka har'a metsoako ea lisele. Sena se tiisa hore metsi a tsoa leseling la lithane tse bokellang ka seleng ebe li ea pele: ka liprotheine tsa methapo ea metsi e fumanehang kahare le metsi a fetisetsoa sebakeng se pakeng tsa methapo ea mali. Ka lebaka leo, moroto o kopaneng o nang le osmolality e phahameng oa thehoa.

Khokahano ea Osmotic ke kakaretso ea lintho tsohle tse qhibilihileng. E ka hlalosoa e le osmolarity mme e lekantsoe ka osmol / l kapa joalo ka osmolality ho osmol / kg. Phapang pakeng tsa osmolarity le osmolality e ka har'a mokhoa oa ho fumana boleng bona. Bakeng sa osmolarity, ena ke mokhoa oa lipalo bakeng sa pokello ea li-electrolyte tsa mantlha mokelikeli o lekantsoeng. Mokhoa o sebelisoang bakeng sa ho bala osmolarity:

Osmolarity = 2 x + glucose (mmol / l) + urea (mmol / l) + 0,03 x protein kaofela ().

Ho osmolality ea plasma, moroto le maro a mang a tlhaho ke khatello ea osmotic, e itšetlehileng ka palo ea ions, tsoekere le urea, e ikemiselitseng ho sebelisa sesebelisoa sa osmometer. Osmolality e tlase ho osmolarity ke boholo ba khatello ea oncotic.

Ka secretion e tloaelehileng ea ADH, osmolarity ea moroto e lula e phahame ho feta 300 mOsm / l mme e ka nyolohela ho 1200 mOsm / l le ho feta. Ka lebaka la khaello ea ADH, moriti oa hau oa moroto o ka tlase ho 200 mosm / l 4, 5.

Lintho tse amanang le lefu la tsoekere le bohareng ba lefu la tsoekere

Har'a lisosa tsa mantlha tsa nts'etsopele ea LPC, mofuta oa lefa la lefu lena o fetisoa o fetisoa ke mofuta oa lefa. Ho ba teng ha lefu lena ho ka qaloa ka meloko e mengata mme ho ka ama litho tse 'maloa tsa malapa, ho bakoa ke liphetoho tse lebisang phetohong ea ADH (DIDMOAD syndrome). Liphoso tsa Congenital anatomical ho nts'etsopele ea bohareng le diencephalon le tsona e ka ba lisosa tsa mantlha tsa kholo ea lefu le tlase la khatello ea kelello. Maemong a 50-60%, sesosa sa bohloko ba khatello e tlase se ke ke sa thehoa - sena ke seo ho thoeng ke idiopathic lefu la tsoekere.

Har'a lisosa tsa bobeli tse lebisang tlhabong ea tsamaiso ea methapo e bohareng, ho sithabela maikutlo (ho soetseha, ho lemala ka leihlo, ho robeha ha sekhahla sa lehata) ho bitsoa trauma.

Nts'etsopele ea NSD ea bobeli e kanna ea amahanngoa le maemo kamora ts'ebetso ea transcranial kapa transsphenoidal gland bakeng sa li-tumor tsa mokokotlo tse kang craniopharyngioma, pinealoma, germinoma, e lebisang ho compression le atrophy ea gland ea morao.

Liphetoho tsa ho ruruha ho hypothalamus, pampitšana ea "supraopticohypophysial", "fun", maoto, li-gland tsa posterior le tsona ke lisosa tsa bobeli tsa kholo ea khatello e tlase.

Ntho e ka sehloohong e hlahisang lefu lena ke tšoaetso. Har'a maloetse a tšoaetsanoang a tšoaetsanoang, feberu, encephalitis, meningitis, tonsillitis, feberu e matla, khohlela e ntse e khetholoha, har'a mafu a sa foleng a tšoaetsanoang - lefuba, brucellosis, syphilis, 'mala, rheumatism 9, 10.

Har'a lisosa tsa khatello ea methapo ea methapo e ka tlase ho khatello ea methapo ke dysplasia ea Skien, tšilafalo ea mali ho methapo ea methapo ea methapo, thrombosis le aneurysm.

Ho latela sebaka sa anatomical, LPC e ka ba ea ka ho sa feleng kapa ea nakoana. Ka tšenyo ea "supraoptic" le "patraoptic", ts'ebetso ea ADH ha e fole.

Nts'etsopele ea nephrogenic ND e ipapisitse le mathata a tlhaho a receptor kapa enzymatic ea li-distal tubules tsa liphio, e lebisang khanyetsong ea li-receptors ketsong ea ADH. Maemong ana, litaba tsa lefu la tlhaho ea ADH li ka ba tloaelehileng kapa tsa phahamisoa, mme ho nka ADH ha ho felise matšoao a lefu lena. Nephrogenic ND e ka hlaha tšoaetsong ea nako e telele ea ho ruruha ha urinithi, urolithiasis (ICD), le prostate adenoma.

Symbphatic nephrogenic ND e ka hlaha ho mafu a tsamaeang le ts'enyo ea lithane tsa distal tsa liphio, tse kang anemia, sarcoidosis, amyloidosis. Maemong a hypercalcemia, kutloelo-bohloko ea ADH ea fokotseha le ho khutlisoa ha metsi hoa fokotseha.

Psychogenic polydipsia e hlaha tsamaisong ea methapo haholo ho basali ba lilemo tsa ho khaotsa ho ilela khoeli (Tafoleng 1). Ketsahalo ea mantlha ea lenyora e bakoa ke mathata a teng bohareng ba lenyora. Tlas'a tšusumetso ea metsi a mangata le keketseho ea bongata ba plasma e potolohang, ho fokotseha ha secretion ea ADH ho etsahala ka mochine oa baroreceptor. A urinalysis ho ea ka Zimnitsky ho bakuli bana e senola ho fokotseha ha letsoalo le itseng, athe ho imeloa ha sodium le osmolarity ea mali li ntse li tloaelehile kapa li fokotsehile. Ha ho fokotsa ho kenella ha mokelikeli, bophelo bo botle ba bakuli bo lula bo khotsofatsa, ha bongata ba moroto bo fokotseha, 'me ho tsofala ha eona ho nyoloha ho fihla meeling ea' mele.

Setšoantšo sa kliniki sa "insipidus" ea tsoekere e bohareng

Bakeng sa ponahatso ea ND, ho hlokahala ho fokotsa bokhoni ba sephiri ba neurohypophysis ka 85% 2, 8.

Matšoao a mantlha a ND ke ho ruruha ho feteletseng le lenyora le tebileng. Khafetsa bophahamo ba moriti o feta lilithara tse 5, bo ka fihla le lilithara tse 8-10 ka letsatsi.

Hyperosmolarity ea plasma ea mali e tsosa bohareng ba lenyora. Mokuli a ke ke a etsa ntle le ho nka mokelikeli nako e fetang metsotso e 30. Palo ea mokelikeli o nooang ke mofuta o fokolang oa lefu hangata e fihla ho lilithara tse 3-5, ka tekano e lekanang - lilitha tse 5-8, ka foromo e boima - lilitha tse 10 kapa ho feta. Motsoako oa morara oa qhalanngoa; boholo ba eona bo boholo ke 1000-1003. Maemong a ho ja metsi ho feta tekano ho bakuli, takatso ea lijo ea fokotseha, mpa e otlolohile, secretion ea fokotseha, motility oa mpa o ea fokotseha, ho sokela hoa hlaha. Ha sebaka sa hypothalamic se angoa ke ts'ebetso ea ho ruruha kapa e sithabetsang, hammoho le ND, mathata a mang a ka bonoa, joalo ka botenya, pathology ea kholo, galactorrhea, hypothyroidism, lefu la tsoekere (DM) 3, 5. Ka tsoelo-pele ea lefu lena, ho felloa ke metsi ho lebisa letlalong le omileng la mucous, le ho fokotseha hoa mathe - le ho fufuleloa, nts'etsopele ea stomatitis le nasopharyngitis. Ka ho omella haholo, bofokoli bo akaretsang, ho ba le phallo ea mali ho qala ho eketseha, ho fokotseha ha khatello ea mali ho hlokomeleha, hlooho e opa ka potlako, ho nyekeloa ke pelo. Bakuli ba teneha, ho ka ba le lipono, ho tsitsipana, lipolao tse ling.