History of Diabetes Insipidus.

Under physiological conditions, fluid and electrolyte homoeostasis is maintained by the kidney adjusting urine volume and composition according to body needs. Diabetes Insipidus is a complex and heterogeneous clinical syndrome affecting water balance and characterized by constant diuresis, resulting in large volumes of dilute urine. With respect to the similarly named Diabetes Mellitus, a disease already known in ancient Egypt, Greece and Asia, Diabetes Insipidus has been described several thousand years later. In 1670s Thomas Willis, noted the difference in taste of urine from polyuric subjects compared with healthy individuals and started the differentiation of Diabetes Mellitus from the more rare entity of Diabetes Insipidus. In 1794, Johann Peter Frank described polyuric patients excreting nonsaccharine urine and introduced the term of Diabetes Insipidus. An hystorical milestone was the in 1913, when Farini successfully used posterior pituitary extracts to treat Diabetes Insipidus. Until 1920s the available evidence indicated Diabetes Insipidus as a disorder of the pituitary gland. In the early 1928, De Lange first observed that some patients with Diabetes Insipidus did not respond to posterior pituitary extracts and subsequently Forssman and Waring in 1945 established that the kidney had a critical role for these forms of Diabetes Insipidus resistant to this treatment. In 1947 Williams and Henry introduced the term Nephrogenic Diabetes Insipidus for the congenital syndrome characterized by polyuria and renal concentrating defect resistant to vasopressin. In 1955, du Vigneaud received the 1955 Nobel Prize in chemistry for the first synthesis of the hormone vasopressin representing a milestone for the treatment of Central Diabetes Insipidus.

Erich Frank (1884-1957): unsung pioneer in nephrology.

The period between the 2 World Wars was a time of budding interest in renal studies and one that closed in major geopolitical unrest, culminating in World War II. The life of Erich Frank (1884-1957) and his contributions to chronic kidney disease provide considerable insight into this period. Frank began his career in Breslau, Germany. His medical thesis and first publication were on the benign nature of orthostatic proteinuria. He went on to define and differentiate essential from renal hypertension, presented evidence for the role of the posterior pituitary in diabetes insipidus, and studied the first oral hypoglycemic agent. As all clinical scientists then, Frank also contributed to other fields of medicine. When Germany turned to Nazism, Frank moved to Turkey, where he was appointed co-chair of the Department of Medicine of the newly established Istanbul University. For the next 23 years, he trained a new generation of modern physicians and laid the foundation of several medical disciplines in Turkey. As author of the first Turkish textbook of nephrology and a teacher who inspired his students, some of whom went on to become the first generation of Turkish nephrologists, Frank was a pioneer in nephrology who helped establish the discipline in his adopted country.

A history of diabetes insipidus: paving the road to internal water balance.

Diabetes insipidus is an ancient disease considered under the rubric of diabetes, the Greek descriptive term for polyuria, which was unrecognized even after the sweetness of urine was reported as a characteristic of diabetes mellitus in the 17th century. It would be another century before diabetes insipidus was identified from the insipid rather than saccharine taste of urine in cases of polyuria. After its increased recognition, pathologic observations and experimental studies connected diabetes insipidus to the pituitary gland in the opening decades of the 20th century. Simultaneously, posterior pituitary lobe extracts were shown to be vasoconstrictive (vasopressin) and antidiuretic (antidiuretic hormone). As vasopressin was purified and synthesized and its assay became available, it was shown to be released in response to both osmotic and volume stimuli that are integrated in the hypothalamus, and vasopressin thereby was essential to maintaining internal water balance. The antidiuretic properties of vasopressin to treat the rare cases of diabetes insipidus were of limited clinical utility until its vasoconstrictive effects were resuscitated in the 1970s, with the consequent increasing wider use of vasopressin for the treatment of compromised hemodynamic states. In addition, the discovery of antidiuretic hormone receptor blockers has led to their increasing use in managing hypo-osmolar states.

[Gustave Roussy's (1874-1948) contribution to neuroendocrinology]. / Gustave Roussy (1874-1948): sa contribution à la neuroendocrinologie.

Gustave Roussy (1874-1948) is remembered as a distinguished French neuropathologist and a leader in the field of oncology. However, his original contribution to the study of hypothalamic functions and neuroendocrinology remains ignored. Among Roussy's discoveries is the first experimental demonstration of the hypothalamic origin of diabetes insipidus and adiposo-genital dystrophy. Also, based on his own histological work, he pioneered the concept of neurosecretion, which was termed by him "neuricrinie".

Diabetes insipidus: historical aspects.

The contributions to our present knowledge and understanding of diabetes insipidus are briefly surveyed. Though a disease presenting with polyuria and thirst had been recognized since Antiquity, it was not until the 17. Century the distinction was made between diabetes insipidus and diabetes mellitus. At the beginning of the 20. Century almost nothing was known about the function of the pituitary. It was generally believed that diabetes insipidus was a renal disease. Two clinical observations in 1912 suggested an association between the hypophysis and diabetes insipidus. This view was supported by the recognition in 1913 that extract of the posterior lobe of the pituitary was effective in diabetes insipidus. Despite much evidence to the contrary, it was assumed that the antidiuretic hormone was produced in the intermediate lobe of the pituitary. Around 1950 it was finally established that 'the posterior lobe hormones' are in fact secreted in the hypothalamus. At the same time the antidiuretic hormone was isolated and synthesized. More recently, progress within genetics has made it possible to characterize in details other rare types of diabetes insipidus.

[Pierre J. Desault and the birth of nephrology 1785-1795]. / La néphrologie naît avec Pierre J. Desault en 1785-1795.

Desault's genius and methods opened up a new field, the pathology of those medical conditions which afflict the urinary apparatus. Though he was a surgeon and therefore an anatomically based clinician, his most important discoveries were in pathological physiology, the polyuria of atrophic kidneys, the fatal dehydratation which follows the various forms of polyuric diabetes, and the oligo-anurias which follow excess water loss from the gut, the lungs ... etc. In the last two conditions the kidneys might look normal and therefore might be presumed normal. If Desault's work had survived this physiological eruption into renal disorders would have been the first decisive step of modern nephrology. His message, though excellent, was delivered too soon and on barren soil, to poorly educated physicians who paid little attention. But then, one has to remember that Desault was just a surgeon!

Diabetes insipidus and blindness caused by a suprasellar tumor: Pieter Pauw's observations from the 16th century.

Tumors in the suprasellar region may cause both visual and endocrinologic symptoms. This association, well known to modern physicians, was established during the 19th century. However, we have identified a 16th-century autopsy report, written by the Dutch professor of anatomy Pieter Pauw (1564-1617), which describes an 18-year-old girl who developed marked polyuria and subsequently became totally blind from a cystic tumor compressing the optic chiasm. Based on prevailing theories on the nature of diabetes, Pauw attributed the disease to the kidneys. Undoubtedly, however, his lucid report is the earliest known account of diabetes insipidus caused by an arachnoid cyst, the Rathke cleft cyst, or craniopharyngioma in the region of the pouch of Rathke. The description also gives insights into the role of anatomic dissections in late 16th-century northern Europe.