Further clinical pictures | Endocrinology

Further clinical pictures

The uncommon diabetes is a chronic metabolic disorder. There are two types, a relative and an absolute insulin deficiency. The basic problem is a permanent increase in blood sugar (hyperglycemia).

The cause is an insufficient effect of the important hormone insulin.Diabetes mellitus type 1 is characterized by an absolute insulin deficiency. The hormone-producing cells of the pancreas are destroyed by an autoimmune reaction and are therefore unable to function. The disease usually manifests itself at a young age and must inevitably be treated by administering insulin from outside.

In contrast, diabetes mellitus type 2 is a relative insulin deficiency, since either too little insulin is produced in the pancreas or the effect on the target organs is reduced. In the latter case, one also speaks of a so-called insulin resistance. The majority of this type of resistance is due to the metabolic syndrome (“prosperity disease”).

This also explains in part the well-known name “old-age diabetes”, which can no longer be counted today because the factors overweight (especially body fat on the abdomen), elevated blood fat values, high blood pressure and glucose tolerance disorder (probably due to excessive consumption) also affect more and more younger people. The term “relative” therefore means that insulin is available, but the amount is not sufficient to cover the demand. As a rule, these patients are also dependent on an external administration, but they can positively intervene in this control cycle by changing their lifestyle, such as a healthy diet and exercise.

This relatively rare hormone deficiency carcinoma leads to a so-called polyuria (extremely high urine excretion) of up to 25 liters per day, resulting in polydypsis (increased thirst). This is based on a defective regulation or reduced release of ADH (antidiuretic hormone) from the hypothalamus. Normally, the hormone is secreted during so-called osmoregualtion, so that more water can be reabsorbed in the kidney through the incorporation of aquaporins (“water channels”) or is not lost to the body.

The reduction of ADH thus explains the sometimes enormous amounts of excreted urine. Depending on the area in which the disorder is located, in the brain or in the kidney “on site”, an additional distinction is made between diabetes inspidus centralis or renalis. This clinical picture is also a disturbance of the balance of osmoregulation.

However, Schwartz-Bartter syndrome is based on increased secretion of ADH (antidiuretic hormone, vasopressin). This results in significantly reduced fluid excretion via the kidneys or urine. This results in a so-called hypotonic hyperhydration with dilution sodiumemia.

This means that too much water is available to the body and blood circulation, the blood is “diluted” and thus the concentration of important electrolytes such as sodium is reduced. The most common cause is a paraneoplastic effect of a small bronchial carcinoma (“accompanying symptoms of cancer“), but there are also numerous other causes such as trauma, hypothyroidism or medication. This clinical picture bears this name because the acra (hands, fingers, feet, ears, nose …) visibly develop larger and grow further.

The internal organs are also affected. It is based on an adenoma (benign) tumor of the pituitary gland, which causes it to secrete more growth hormone (somatotropin, STH or GH).