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Article
February 2, 1957

THERAPEUTIC PROBLEMS IN DIABETES INSIPIDUS

JAMA. 1957;163(5):341-344. doi:10.1001/jama.1957.02970400013005
Abstract

• Diabetes insipidus as seen in experimental animals after cutting the supraopticohypophysial tracts usually passes through three phases. This explains some phenomena seen in human subjects. In the first case here described, surgery in the vicinity of the optic chiasm was followed (a) by a polyuria of 27,930 cc. in 24 hours, then (b) by a gradual return to normal urinary output at about the sixth day, and finally, after about three days of normal output, (c) by establishment of a permanent phase of diabetes insipidus amenable to treatment with vasopressin tannate. Animal experiments suggest that the interphase (b) can be explained as meaning a transient outpouring of antidiuretic hormone by the detached, degenerating posterior lobe. The permanent phase (c) then represents exhaustion of the antidiuretic material from the posterior lobe. Severe diabetes insipidus is known to occur only in the presence of a functioning anterior pituitary lobe. In the third case here described, a polyuria had existed for more than six years in the presence of signs of hypophysial disease. A spontaneous amelioration of the polyuria was then noted concurrently with signs that the anterior lobe was failing; the polyuria returned after treatment with cortisone was begun. Spontaneous remission in a long-standing case of diabetes insipidus should alert the clinician to the possibility that the anterior lobe of the hypophysis is becoming involved in the disease process.

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