Nephrogenic Diabetes Insipidus. An Unusual Presentation of Recurrent Rectal Cancer

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Title: Nephrogenic Diabetes Insipidus. An Unusual Presentation of Recurrent Rectal Cancer
Authors: Nobels, Frank; Colemont, Luc; Goethals, Marnix; Abs, Roger
Publisher: Cancer
Date Published: November 01, 1991
Reference Number: 312
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The occurrence of diabetes insipidus (DI) in patients with systemic cancer is caused usually by tumor metastasis to the hypothalamus or posterior pituitary. A 43-year-old man with DI 8 months after radical surgery for a poorly differentiated adenocarcinoma of the distal rectum is reported. A therapeutic trial of intranasal desmopressin acetate did not correct the hyposthenuria, thus localizing the defect to the kidneys. A large tumor recurrence in the pelvis caused bilateral hydroureteronephrosis, resulting in nephrogenic DI. This report shows that not all cases of DI in cancer patients are of central origin.
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This translation by the NDI Foundation is to assist the lay reader. To provide a clear, accessible interpretation of the original article, we eliminated or simplified some technical detail and complicated scientific language. We concentrated our translation on those aspects of the article dealing directly with NDI. The NDI Foundation thanks the researchers for their work toward understanding and more effectively treating this disorder.
© Copyright NDI Foundation 2007 (JC)

Nobels, et al., report on a rare form of nephrogenic diabetes insipidus (NDI) caused by partial obstruction of both ureters (the tubes that transport urine from kidney to bladder). The obstruction was brought on by a recurrence of the patient's rectal cancer.

Eight months after this 43-year-old male underwent radical surgery for his rectal cancer he began to display polyuria (the chronic passage of large amounts of urine) and polydipsia (chronic, excessive thirst). He was administered DDAVP, a synthetic analog of the antidiuretic hormone, arginine vasopressin (AVP), but this gave no relief of his symptoms. This indicated his diabetes insipidus (DI) was nephrogenic instead of neurogenic. Most DI in cancer patients is neurogenic because the cancer often affects the pituitary. The pituitary produces and excretes AVP, so if it can't do that, then there is no AVP to initiate urine concentration in, or water reabsorption through the kidney collecting ducts.

The authors discovered that this patient had a recurrent tumor in his pelvis that caused a partial obstruction of both ureters, which, the authors speculated, exerted undue pressure on the kidney collecting ducts. AVP must bind with vasopressin-2 receptors in the principal cells of the kidney collecting ducts if it is to initiate urine concentration and water reabsorption there. If it could not, due to pressure-induced damage, this could be the cause of the patient's NDI.