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What Causes Frequent Urination, Extreme Thirst And Hunger Post Intake Of Sunitinib?
Question: Hello Doctor,
My father, aged 63, was diagnosed with kidney cancer (Renal Cell Carcinoma) in late 2013. He experienced Pituitary bleeding (apoplexy), exactly a month after taking Sutent (Sunitnib, drug prescribed for kidney cancer) for daily. Then onward he faced many hormone problems (Hypothyroid, Cortisol deficiency). Currently he is facing an episode of frequent urination coupled with extreme thirst and hunger but he is aware whenever the urine urgency happens, and the urine looks pale like clear water unlike normal color of urine. It is going on for 3 days. The urine comes like every 30 minutes. And, no issue with bowel movement. He is in our native, XXXXXXX In XXXXXXX there seems to be no endocrinology at least to my knowledge. Need a opinion as to why this is happening and tests to take for diagnosis?
Since he is already having the pituitary problem, could this be a symptom of Diabetes insipidus due to some problem in production of antidiuretic hormone...Will it help to include any urologist also for diagnosis? How to control the frequency of urine, as he is not able to sleep whole day including night?
I have read about types of Diabetes insipidus.
1. Neurogenic - Due to pituitary's inability to produce ADH.
2. Nephrogenic - Due to the inability of the kidney to respond normally to vasopressin/ADH. he has cancer mass in right kidney.
3. Dipsogenic - Happens regardless of ADH, due to a defect or damage to the thirst mechanism, located in the hypothalamus
Please help us as to how to properly diagnosis and find out the type and advise the respective treatment.
I am more than willing to provide any details you may need.
Thanks.
My father, aged 63, was diagnosed with kidney cancer (Renal Cell Carcinoma) in late 2013. He experienced Pituitary bleeding (apoplexy), exactly a month after taking Sutent (Sunitnib, drug prescribed for kidney cancer) for daily. Then onward he faced many hormone problems (Hypothyroid, Cortisol deficiency). Currently he is facing an episode of frequent urination coupled with extreme thirst and hunger but he is aware whenever the urine urgency happens, and the urine looks pale like clear water unlike normal color of urine. It is going on for 3 days. The urine comes like every 30 minutes. And, no issue with bowel movement. He is in our native, XXXXXXX In XXXXXXX there seems to be no endocrinology at least to my knowledge. Need a opinion as to why this is happening and tests to take for diagnosis?
Since he is already having the pituitary problem, could this be a symptom of Diabetes insipidus due to some problem in production of antidiuretic hormone...Will it help to include any urologist also for diagnosis? How to control the frequency of urine, as he is not able to sleep whole day including night?
I have read about types of Diabetes insipidus.
1. Neurogenic - Due to pituitary's inability to produce ADH.
2. Nephrogenic - Due to the inability of the kidney to respond normally to vasopressin/ADH. he has cancer mass in right kidney.
3. Dipsogenic - Happens regardless of ADH, due to a defect or damage to the thirst mechanism, located in the hypothalamus
Please help us as to how to properly diagnosis and find out the type and advise the respective treatment.
I am more than willing to provide any details you may need.
Thanks.
Brief Answer:
Needs a water deprivation test
Detailed Answer:
Hi,
Welcome to HCM. I have gone through your questions and understand your concerns.
This could be most likelydiabetes insipidus (DI). The type of DI can be determined by a water deprivation test.
Here your father will be admitted in a hospital for few hours and asked to avoid drinking or eating for few hours. The blood and urine is tested every hour and when sodium levels go up an injection of vasopressin (ADH) is given to see if sodium can be brought back to normal. If body respond to ADH it is pituitary DI, if not it is nephrogenic DI. In psychogenic polydipsia the sodium level will be low and won't rise above normal limits.
Unfortunately these tests are done by endocrinologists. If facilities are not available you can do as follows:
1. Buy Minrin nasal spray ( which is ADH) - available only in major pharmacies
2. Ask your father to take nill per orally for 4 hours or as long as he can hold his thirst
3. Check his serum sodium, serum osmolality, and urine osmolality after that
4. Give Minrin nasal spray one puff in each nostril.
5. Ask him to take water normally according to the thirst after the spray
6. Repeat the blood and urine test after 2 and 4 hours
If there is improvement after the spray ask him to continue one puff twice daily. The symptoms will improve dramatically.
Please do the tests under supervision by atleast an MBBS doctor.
If you need to consult an endocrinologist in Thirunelveli, I recommend to see Dr Bharath in Kidney Care Centre, Thirunelveli ( he comes there monthly once).
Hope I have answered your questions. If you have any further questions, I will be pleased to help you.
Regards
Dr Ajish TP
Needs a water deprivation test
Detailed Answer:
Hi,
Welcome to HCM. I have gone through your questions and understand your concerns.
This could be most likelydiabetes insipidus (DI). The type of DI can be determined by a water deprivation test.
Here your father will be admitted in a hospital for few hours and asked to avoid drinking or eating for few hours. The blood and urine is tested every hour and when sodium levels go up an injection of vasopressin (ADH) is given to see if sodium can be brought back to normal. If body respond to ADH it is pituitary DI, if not it is nephrogenic DI. In psychogenic polydipsia the sodium level will be low and won't rise above normal limits.
Unfortunately these tests are done by endocrinologists. If facilities are not available you can do as follows:
1. Buy Minrin nasal spray ( which is ADH) - available only in major pharmacies
2. Ask your father to take nill per orally for 4 hours or as long as he can hold his thirst
3. Check his serum sodium, serum osmolality, and urine osmolality after that
4. Give Minrin nasal spray one puff in each nostril.
5. Ask him to take water normally according to the thirst after the spray
6. Repeat the blood and urine test after 2 and 4 hours
If there is improvement after the spray ask him to continue one puff twice daily. The symptoms will improve dramatically.
Please do the tests under supervision by atleast an MBBS doctor.
If you need to consult an endocrinologist in Thirunelveli, I recommend to see Dr Bharath in Kidney Care Centre, Thirunelveli ( he comes there monthly once).
Hope I have answered your questions. If you have any further questions, I will be pleased to help you.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctor. This is very informative.
I understand that in case of neurogenic minrin 0.1 mg oral per day is treatment. In case of Nephrogenic, what is the treatment? Also, how to distinguish whether it is Dipsogenic or not and what is the treatment for that?
I understand that in case of neurogenic minrin 0.1 mg oral per day is treatment. In case of Nephrogenic, what is the treatment? Also, how to distinguish whether it is Dipsogenic or not and what is the treatment for that?
Brief Answer:
Diuretics, sodium levels
Detailed Answer:
Hi,
Welcome back.
1. In pituitary( nephrogenic) DI Minrin is used either as 0.1 mg tablets or Minrin nasal spray 1 puff twice daily
2. The treatment of nephrogenic diabetes - low salt diets and medications ( Thiazides + Amiloride available as Biduret, Aquazide etc) started as once daily initially followed by 2 tablets a day
3. In Dipsogenic ( Psychogenic polydipsia) DI the sodium levels will be low( high in other two forms of DI) and the urine osmolality increase (Wont increase in other two) when the patient stop taking water.
Regards
Dr Ajish TP
Diuretics, sodium levels
Detailed Answer:
Hi,
Welcome back.
1. In pituitary( nephrogenic) DI Minrin is used either as 0.1 mg tablets or Minrin nasal spray 1 puff twice daily
2. The treatment of nephrogenic diabetes - low salt diets and medications ( Thiazides + Amiloride available as Biduret, Aquazide etc) started as once daily initially followed by 2 tablets a day
3. In Dipsogenic ( Psychogenic polydipsia) DI the sodium levels will be low( high in other two forms of DI) and the urine osmolality increase (Wont increase in other two) when the patient stop taking water.
Regards
Dr Ajish TP
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Answered by
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