DIABETES INSIPIDUS 867 



Symptoms and Signs 



The character of the phenomena exhibited by a patient depends on 

 many factors, chief $of which are the nature and location of the lesion, 

 age of patient, and time of onset. The symptoms and signs are many 

 and varied. Polyuria, polydipsia, anhidrosis, visual disturbances, and 

 impairment of the sex gland function are among the most important. 



The amount of urine passed in twenty-four hours may range from 

 three to forty liters, the volume usually being from five to seven liters. 

 The specific gravity is low and in inverse ratio to the amount voided. 

 It rarely exceeds 1.008 and may be as low as 1.001. Polyuria may be the 

 most striking symptom. A degree of thirst may be present which in 

 most cases is insatiable. Some patients will drink fluids almost constantly 

 and without evident relief. In adult cases, there is frequently a balance 

 between intake and outgo, but in the young oftentimes fluid will be con- 

 sumed greatly in excess of that voided in the urine. The skin is gen- 

 erally dry and harsh, due to the inaction of the sweat and sebaceous glands. 

 Leucodermia, may be present. 



In adult cases, the hair in the axillae and pubes may be very thin 

 or entirely absent. The eyebrows and scalp do not appear to be involved. 

 The beard may be scanty or grow very slowly. These changes in body 

 hair follow rapidly after the onset of the polyuria. 



The body temperature is often subnormal, 96 degrees Fahrenheit 

 not being unusual, and the pulse may be slow. The blood pressure may 

 be low except in those cases complicated by cardiorenal disease. In cases 

 in which the sweat glands do not function and their heat regulation action 

 is lost, there may be considerable elevation of body temperature on hot 

 days. Stoermer reported that one of his cases, unable to sweat, on such 

 an occasion had a body heat of 102.9 degrees Fahrenheit. 



Somnolence and marked weakness, tiring on slight exertion, are strik- 

 ing symptoms. The patient may be apathetic and disinclined to help him- 

 self or cooperate in treatment. Mental depression and melancholia may 

 be evident. 



In his early work, Gushing pointed out that patients with hypo- 

 pituitarism usually had an increased capacity to utilize carbohydrates; 

 and since the syndrome of diabetes insipidus was thought to be due to a 

 deficiency in function of the hypophysis, increased carbohydrate tolerance 

 as determined by the presence of alimentary glycosuria was looked upon 

 as one of the cardinal symptoms. Abrahamson and Climenko question 

 the value of this conclusion believing that the same phenomenon is ob- 

 served in other morbid states. In the experimental work of Camus and 

 Roussy on dogs, partial or total removal of the pituitary body did not 

 appear to modify the tolerance for carbohydrates, nor cause the appear- 



