This article reviewed the current knowledge on time-course manifestation of diabetic urethral dysfunction (DUD), and explored an early intervention target to prevent the contribution of DUD to the progression of diabetes-induced impairment of the lower urinary tract (LUT). In the literature search through PubMed, key words used included “diabetes mellitus,” “diabetic urethral dysfunction,” and “diabetic urethropathy.” Polyuria and hyperglycemia induced by diabetes mellitus (DM) can cause the time-dependent changes in functional and morphological manifestations of DUD. In the early stage, it promotes urethral dysfunction characterized by increased urethral pressure during micturition. However, the detrusor muscle of the bladder tries to compensate for inducing complete voiding by increasing the duration and amplitude of bladder contractions. As the disease progresses, it can induce an impairment of coordinated micturition due to dyssynergic activity of external urethra sphincter, leading to detrusor-sphincter dyssynergia. The impairment of relaxation mechanisms of urethral smooth muscles (USMs) may additionally be attributable to decreased responsiveness to nitric oxide, as well as increased USM responsiveness to α1-adrenergic receptor stimulation. In the late stage, diabetic neuropathy may play an important role in inducing LUT dysfunction, showing that the decompensation of the bladder and urethra, which can cause the decrease of voiding efficiency and the reduced thickness of the urothelium and the atrophy of striated muscle bundles, possibly leading to the vicious cycle of the LUT dysfunction. Further studies to increase our understandings of the functional and molecular mechanisms of DUD are warranted to explore potential targets for therapeutic intervention of DM-induced LUT dysfunction.
Ataxia ; Atrophy ; Diabetes Mellitus ; Diabetic Neuropathies ; Early Intervention (Education) ; Hyperglycemia ; Lower Urinary Tract Symptoms ; Muscle, Smooth ; Muscle, Striated ; Nitric Oxide ; Polyuria ; Relaxation ; Urethra ; Urinary Bladder ; Urinary Tract ; Urination ; Urothelium

The rhizomes of Dioscorea japonica Thunb. are widely consumed as food and also used to treat diabetes and polyuria in Korea. This study was undertaken to study the anti-atopic dermatitis effects of a 95% ethanolic extract (DJE) of D. japonica in an oxazolone-stimulated murine model of atopic dermatitis (AD). The therapeutic effects of DJE on AD-like skin lesions were assessed on both ears. DJE (1%) or dexamethasone (0.5%; the positive control) were applied to skin lesions for three weeks. Serum levels of IgE and IL-4 were assessed by ELISA (enzyme-linked immunosorbent assay). Histopathological examinations were performed by hematoxylin and eosin (H&E) and toluidine blue staining and revealed DJE significantly reduced dermal thickness and inflammatory cell infiltration when applied to oxazolone-treated ear skin. DJE-treated AD mice also showed lower serum levels of IgE and IL-4 than oxazolone-stimulated controls. Our findings demonstrate DJE might be a useful safe, topical agent for the treatment of atopic diseases.
Animals ; Dermatitis ; Dermatitis, Atopic ; Dexamethasone ; Dioscorea ; Ear ; Enzyme-Linked Immunosorbent Assay ; Eosine Yellowish-(YS) ; Ethanol ; Hematoxylin ; Immunoglobulin E ; Interleukin-4 ; Korea ; Mice ; Oxazolone ; Polyuria ; Rhizome ; Skin ; Therapeutic Uses ; Tolonium Chloride

Congenital rubella infection is a transplacental infection that can cause intrauterine growth retardation, cataracts, patent ductus arteriosus, hearing loss, microcephaly, thrombocytopenia, and severe fetal injury. It has been shown that type 1 diabetes mellitus develops in 12%–20% of patients with congenital rubella infection, and disorders in the oral glucose tolerance test is observed in 40% of patients. No biochemical or serological markers exist which could indicate that type 1 diabetes was caused by a congenital rubella infection. We report a 13-year-old male patient who was admitted to our hospital with complaints of new-onset polyuria, polydipsia, urination, and weight loss. In addition, he was found to have neurosensory hearing loss, patent ductus arteriosus, and microcephaly. Immunemediated type 1 diabetes mellitus was considered due to the fact that the autoantibodies of diabetes mellitus were positive.
Adolescent ; Autoantibodies ; Cataract ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Ductus Arteriosus, Patent ; Fetal Growth Retardation ; Glucose Tolerance Test ; Hearing Loss ; Humans ; Male ; Microcephaly ; Polydipsia ; Polyuria ; Rubella ; Thrombocytopenia ; Urination ; Weight Loss

Primary polydipsia (PP) is marked by an increase in thirst, and most often presents in patients with psychiatric illnesses. Although uncommon in children, we experienced cases of PP in a 15-month-old boy and a 5-year-old girl. Both were admitted to the hospital with symptoms of polydipsia and polyuria that appeared 1–3 months before admission. Brain magnetic resonance imaging in both patients was normal. A water restriction test was performed after hospitalization and showed normal results. The symptoms improved after the parents were instructed to implement water-intake restriction for 2 weeks. Our report provides useful information for the treatment of PP in children.
Brain ; Child ; Child, Preschool ; Diabetes Insipidus ; Female ; Hospitalization ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Parents ; Polydipsia ; Polydipsia, Psychogenic ; Polyuria ; Thirst ; Water

Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.
Adolescent ; Back Pain ; Biopsy ; Brain ; Brain Neoplasms ; Central Nervous System ; Child ; Comorbidity ; Diagnosis ; Germinoma* ; Headache ; Hemangioma ; Histiocytosis, Langerhans-Cell ; Humans ; Magnetic Resonance Imaging ; Male ; Nausea ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal ; Pineal Gland ; Polydipsia ; Polyuria ; Spine*

A 17-year-old girl presented with polyuria (7 L/day) and polydipsia for one year. Initial urine osmolality was 113mOsm/kg H₂O. Following 6 h of fluid restriction, serum plasma osmolality reached 300mOsm/kg H₂O, whereas urine osmolality was 108mOsm/kg H₂O. Urine osmolality was increased by 427% from 108 to 557mOsm/kg after vasopressin challenge. The patient was diagnosed with central diabetes insipidus, possibly derived from the atypical occupation of a Rathke's cleft cyst at the pituitary stalk following magnetic resonance imaging with enhancement. She was discharged with desmopressin nasal spray (10 µg); urine output was maintained at 2-3 L/day, and urine osmolality was >300 mOsm/kg. Additional pituitary image studies and evaluation of hypopituitarism should be included in the differential diagnosis of patients with central diabetes insipidus.
Adolescent* ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Neurogenic* ; Diagnosis, Differential ; Female* ; Humans ; Hypopituitarism ; Magnetic Resonance Imaging ; Occupations ; Osmolar Concentration ; Pituitary Gland ; Plasma ; Polydipsia ; Polyuria* ; Vasopressins

A 32-year-old pregnant woman (34 + 5 weeks) was admitted with dizziness, nausea, and vomiting. Previously, she was diagnosed with gestational diabetes mellitus at 28 weeks with 100 g-OGTT and insulin therapy was started. Her average fasting glucose level was 97 mg/dL and postprandial 1-hour glucose level was 130 mg/dL with basal-bolus insulin therapy (total dose of 28-30 IU/day). At 34 + 0 weeks of gestational age, polyuria and unexpected weight loss (2 kg/week) with hyperglycemia occurred, and total dose of daily insulin requirement was increased up to 50 IU/day. At admission, her serum glucose level was high (502 mg/dL), and urinalysis revealed ketonuria +3. Arterial blood gas analysis revealed pH of 6.83, pCO2 of 9 mmHg, and bicarbonate of 2 mmol/L with an anion gap of 23.5 mmol/L. The diagnosis of diabetic ketoacidosis was established and emergency caesarean section was conducted due to fetal distress. She was finally diagnosed with fulminant type 1 diabetes mellitus, and multiple daily insulin injection therapy was continued after delivery.
Acid-Base Equilibrium ; Adult ; Blood Gas Analysis ; Blood Glucose ; Cesarean Section ; Diabetes Mellitus, Type 1 ; Diabetes, Gestational* ; Diabetic Ketoacidosis ; Diagnosis ; Dizziness ; Emergencies ; Fasting ; Female ; Fetal Distress ; Gestational Age ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hyperglycemia ; Insulin ; Ketosis ; Nausea ; Polyuria ; Pregnancy* ; Pregnant Women ; Urinalysis ; Vomiting ; Weight Loss

There are two types of refractory nocturnal enuresis. The first type corresponds to patients who are refractory from initial success, and the second type refers to refractory nocturnal enuresis after long-term success, in patients who cannot discontinue medications for enuresis. In the former type, it is necessary to determine whether the timing of medications is appropriate, whether the usage of antidiuretics is appropriate, whether any lifestyle changes have taken place, and whether there are secondary causes of enuresis. In the latter type, enuretic alarm treatment should be considered initially, and it is then important to investigate whether a respiratory obstruction is present in patients with nocturnal polyuria, whether the patient is constipated, and whether patients with non-monosymptomatic nocturnal enuresis have lower urinary tract symptoms or attention deficit hyperactivity disorder.
Attention Deficit Disorder with Hyperactivity ; Drug Resistance ; Drug Therapy ; Enuresis ; Humans ; Life Style ; Lower Urinary Tract Symptoms ; Nocturnal Enuresis* ; Polyuria

The primary causes of uncontrolled diabetes are poor life-style, infection, ischemic heart disease and inappropriate usage of oral anti-diabetic agents and insulin. Supplementary causes are stroke, acute pancreatitis and endocrine diseases. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by primary hyperparathyroidism, pituitary neoplasia, and foregut lineage neuroendocrine tumors, and is associated with increased glucose levels. We present a case of a 69-year-old woman who had polyuria, polydipsia, weight loss and hyperglycemia over 6 months. She had hypertrophy of the face, hand, and foot, and active bleeding and large folds were observed in the stomach and duodenum upon esophagogastroduodenoscopy. She also had high levels of IGF-1 and gastrin and got the failure of growth hormone suppression after an oral glucose load (75 g). These findings suggested a diagnosis of acromegaly and gastrinoma, which was clinically diagnosed along with MEN 1. The patient improved glycemic control and symptoms after being treated with somatostatin analogues and insulin therapy over a 5-month follow-up period. Here, we report a case of MEN 1 in type 2 diabetes mellitus with a poorly controlled blood glucose level. Clinicians should consider endocrine disease in patients with poor glycemic control in diabetes.
Acromegaly ; Aged ; Blood Glucose ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Diagnosis ; Duodenum ; Endocrine System Diseases ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Foot ; Gastrinoma ; Gastrins ; Glucose ; Growth Hormone ; Hand ; Hemorrhage ; Humans ; Hyperglycemia ; Hyperparathyroidism, Primary ; Hypertrophy ; Insulin ; Insulin-Like Growth Factor I ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Myocardial Ischemia ; Neuroendocrine Tumors ; Pancreatitis ; Polydipsia ; Polyuria ; Somatostatin ; Stomach ; Stroke ; Weight Loss

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.
Adolescent ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Neurogenic ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Nephritis, Hereditary ; Osmolar Concentration ; Polyuria* ; Reference Values ; Specific Gravity ; Tissue Donors ; Transplants