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Bithal PK, Jan R, Butt YM, Alshuaibi K. Intraoperative central diabetes insipidus in a postpartum patient during decompression of base of brain lesion: Missing out the diagnosis of Sheehan's syndrome? Saudi J Anaesth 2021; 15:204-206. [PMID: 34188642 PMCID: PMC8191249 DOI: 10.4103/sja.sja_885_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old female presented with headache in the third week postpartum period following uneventful cesarean delivery. She had left sided ptosis, pain, and numbness over left face since third trimester. Post-delivery magnetic resonance imaging revealed invading left sphenoid sinus meningioma. She was planned for combined endonasal and pterional craniotomy. Her preoperative investigations including sodium, glucose, and liver functions were normal. Intraoperatively during endonasal phase a high urine output (UO) with rising sodium were noticed which continued with worsening sodium (156 mEq/L after 3 h). Desmopressin 1 mcg IV administered which normalized UO for the rest of surgical duration with trends of declining sodium (149 mEq/L at the end of procedure). Her postoperative MRI was normal however desmopressin could not be discontinued because of increasing sodium and UO without it. She was discharged on oral desmopressin, hydrocortisone and levothyroxine. On her follow-up 3.5 months later she had normal sodium and normal UO.
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Affiliation(s)
- Parmod K Bithal
- Department of Anesthesiology and Perioperative Medicine, King Fahad Medical City, Riyadh, KSA
| | - Ravees Jan
- Department of Anesthesiology and Perioperative Medicine, King Fahad Medical City, Riyadh, KSA
| | - Yasser Majid Butt
- Department of Anesthesiology and Perioperative Medicine, King Fahad Medical City, Riyadh, KSA
| | - Khalid Alshuaibi
- Department of Anesthesiology and Perioperative Medicine, King Fahad Medical City, Riyadh, KSA
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2
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Abstract
In the pregnant patient, hypotonic polyuria in the setting of elevated serum osmolality and polydipsia should narrow the differential to causes related to diabetes insipidus (DI). Gestational DI, also called transient DI of pregnancy, is a distinct entity, unique from central DI or nephrogenic DI which may both become exacerbated during pregnancy. These three different processes relate to vasopressin, where increased metabolism, decreased production or altered renal sensitivity to this neuropeptide should be considered. Gestational DI involves progressively rising levels of placental vasopressinase throughout pregnancy, resulting in decreased endogenous vasopressin and resulting hypotonic polyuria worsening through the pregnancy. Gestational DI should be distinguished from central and nephrogenic DI that may be seen during pregnancy through use of clinical history, urine and serum osmolality measurements, response to desmopressin and potentially, the newer, emerging copeptin measurement. This review focuses on a brief overview of osmoregulatory and vasopressin physiology in pregnancy and how this relates to the clinical presentation, pathophysiology, diagnosis and management of gestational DI, with comparisons to the other forms of DI during pregnancy. Differentiating the subtypes of DI during pregnancy is critical in order to provide optimal management of DI in pregnancy and avoid dehydration and hypernatremia in this vulnerable population.
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Affiliation(s)
- Sonia Ananthakrishnan
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center, 72 Concord Street, Evans 122, Boston, MA, 02118, United States.
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Calina D, Docea AO, Golokhvast KS, Sifakis S, Tsatsakis A, Makrigiannakis A. Management of Endocrinopathies in Pregnancy: A Review of Current Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050781. [PMID: 30836653 PMCID: PMC6427139 DOI: 10.3390/ijerph16050781] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Abstract
Pregnancy in women with associated endocrine conditions is a therapeutic challenge for clinicians. These disorders may be common, such us thyroid disorders and diabetes, or rare, including adrenal and parathyroid disease and pituitary dysfunction. With the development of assisted reproductive techniques, the number of pregnancies with these conditions has increased. It is necessary to recognize symptoms and correct diagnosis for a proper pharmacotherapeutic management in order to avoid adverse side effects both in mother and fetus. This review summarizes the pharmacotherapy of these clinical situations in order to reduce maternal and fetal morbidity.
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Affiliation(s)
- Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | | | - Stavros Sifakis
- Department of Obstetrics and Gynecology, Mitera Maternity Hospital, 71110 Heraklion, Crete, Greece.
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71110 Heraklion, Crete, Greece.
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece.
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Abstract
Body fluid homeostasis is essential for normal life. In the maintenance of water balance, the most important factor and regulated process is the excretory function of the kidneys. The kidneys are capable to compensate not only the daily fluctuations of water intake but also the consequences of fluid loss (respiration, perspiration, sweating, hemorrhage). The final volume and osmolality of the excreted urine is set in the collecting duct via hormonal regulation. The hormone of water conservation is the vasopressin (AVP), and a large volume of urine is produced and excreted in the absence of AVP secretion or if AVP is ineffective in the kidneys. The aquaporin-2 water channel (AQP2) is expressed in the principal cells, and it plays an essential role in the reabsorption of water in the collecting ducts via type 2 vasopressin receptor (V2R)-mediated mechanism. If neural or hormonal regulation fails to operate the normal function of AVP-V2R-AQP2 system, it can result in various diseases such as diabetes insipidus (DI) or nephrogenic syndrome of inappropriate diuresis (NSIAD). The DI is characterized by excessive production of hyposmotic urine ("insipidus" means tasteless) due to the inability of the kidneys to concentrate urine. In this chapter, we focus and discuss the pathophysiology of nephrogenic DI (NDI) and the potential therapeutic interventions in the light of the current experimental data.
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Affiliation(s)
- András Balla
- Faculty of Medicine, Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - László Hunyady
- Faculty of Medicine, Department of Physiology, Semmelweis University, Budapest, Hungary.
- MTA-SE Laboratory of Molecular Physiology, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
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5
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Pitfall in the Diagnosis of Diabetes Insipidus and Pregnancy. Case Rep Obstet Gynecol 2017; 2017:7879038. [PMID: 28819576 PMCID: PMC5551559 DOI: 10.1155/2017/7879038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/31/2017] [Accepted: 06/22/2017] [Indexed: 11/21/2022] Open
Abstract
Diabetes insipidus (DI) during pregnancy and the perinatal period is an uncommon medical problem characterized by polyuria and excessive thirst. Diagnosis of DI may be overlooked in the setting of pregnancy, a time when increased water intake and urine output are commonly reported. We report two cases: one of transient DI in a young woman during her third trimester of twin pregnancy in association with acute fatty liver and hypertension and one of postpartum DI secondary to Sheehan syndrome from rupture of a splenic artery aneurysm. These cases illustrate the spectrum with which DI related to pregnancy and delivery can present and highlight the difficulty in making the diagnosis since the symptoms are often initially overlooked.
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Harbeck B, Rahvar AH, Danneberg S, Schütt M, Sayk F. Life-threatening endocrine emergencies during pregnancy - management and therapeutic features. Gynecol Endocrinol 2017; 33:510-514. [PMID: 28361555 DOI: 10.1080/09513590.2017.1307959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Endocrine emergencies during pregnancy may be life-threatening events for both mother and fetus. Besides pregnancy-associated endocrine disorders, several pre-existing endocrinopathies such as type-1 diabetes and Grave's disease or adrenal failure may acutely deteriorate during pregnancy. Since "classical" signs are often modified by pregnancy, early diagnosis and management may be hampered. In addition, laboratory tests show altered physiologic ranges and pharmacologic options are limited while therapeutic goals are mostly tighter than in the non-pregnant patient. Though subclinical endocrinopathies are more frequent and worth consideration due to their related adverse sequelae, this article focuses on endocrine emergencies complicating pregnancy.
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Affiliation(s)
- Birgit Harbeck
- a Department of Medicine I , University of Lübeck , Lübeck , Germany and
| | | | - Sven Danneberg
- a Department of Medicine I , University of Lübeck , Lübeck , Germany and
| | - Morten Schütt
- a Department of Medicine I , University of Lübeck , Lübeck , Germany and
| | - Friedhelm Sayk
- b Department of Medicine II , University of Lübeck , Lübeck , Germany
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Tack LJ, T’Sjoen G, Lapauw B. Exacerbation of pre-existing diabetes insipidus during pregnancy, mechanisms and management. Acta Clin Belg 2017; 72:213-216. [PMID: 27654225 DOI: 10.1080/17843286.2016.1235244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
During pregnancy, physiological changes in osmotic homeostasis cause water retention. If excessive, this can cause gestational diabetes insipidus (DI), particularly in patients with already impaired vasopressin secretion. We present the case of a 34-year-old patient with pre-existing hypopituitarism who experienced a transient exacerbation of her DI during a twin pregnancy. In contrast to typical gestational DI, polyuria and polydipsia occurred during the first trimester and remained stable thereafter. This case highlights a challenging clinical entity of which pathophysiology, diagnostic approach and treatment will be discussed.
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Affiliation(s)
- Lloyd J.W. Tack
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Guy T’Sjoen
- Division of Endocrinology, Department Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Division of Endocrinology, Department Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
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8
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Abstract
Diabetes insipidus (DI) in pregnancy is a heterogeneous syndrome, most classically presenting with polyuria and polydipsia that can complicate approximately 1 in 30,000 pregnancies. The presentation can involve exacerbation of central or nephrogenic DI during pregnancy, which may have been either overt or subclinical prior to pregnancy. Women without preexisting DI can also be affected by the actions of placental vasopressinase which increases in activity between the 4th and 38th weeks of gestation, leading to accelerated metabolism of AVP and causing a transient form of DI of pregnancy. This type of DI may be associated with certain complications during pregnancy and delivery, such as preeclampsia. Management of DI of pregnancy depends on the pathophysiology of the disease; forms of DI that lack AVP can be treated with desmopressin (DDAVP), while forms of DI that involve resistance to AVP require evaluation of the underlying causes.
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Affiliation(s)
- Sonia Ananthakrishnan
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center, 88 East Newton Street, H-3600, Boston, MA 02118, USA.
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9
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Marques P, Gunawardana K, Grossman A. Transient diabetes insipidus in pregnancy. Endocrinol Diabetes Metab Case Rep 2015; 2015:150078. [PMID: 26524979 PMCID: PMC4626653 DOI: 10.1530/edm-15-0078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/23/2015] [Indexed: 11/28/2022] Open
Abstract
Gestational diabetes insipidus (DI) is a rare complication of pregnancy, usually developing in the third trimester and remitting spontaneously 4–6 weeks post-partum. It is mainly caused by excessive vasopressinase activity, an enzyme expressed by placental trophoblasts which metabolises arginine vasopressin (AVP). Its diagnosis is challenging, and the treatment requires desmopressin. A 38-year-old Chinese woman was referred in the 37th week of her first single-gestation due to polyuria, nocturia and polydipsia. She was known to have gestational diabetes mellitus diagnosed in the second trimester, well-controlled with diet. Her medical history was unremarkable. Physical examination demonstrated decreased skin turgor; her blood pressure was 102/63 mmHg, heart rate 78 beats/min and weight 53 kg (BMI 22.6 kg/m2). Laboratory data revealed low urine osmolality 89 mOsmol/kg (350–1000), serum osmolality 293 mOsmol/kg (278–295), serum sodium 144 mmol/l (135–145), potassium 4.1 mmol/l (3.5–5.0), urea 2.2 mmol/l (2.5–6.7), glucose 3.5 mmol/l and HbA1c 5.3%. Bilirubin, alanine transaminase, alkaline phosphatase and full blood count were normal. The patient was started on desmopressin with improvement in her symptoms, and normalisation of serum and urine osmolality (280 and 310 mOsmol/kg respectively). A fetus was delivered at the 39th week without major problems. After delivery, desmopressin was stopped and she had no further evidence of polyuria, polydipsia or nocturia. Her sodium, serum/urine osmolality at 12-weeks post-partum were normal. A pituitary magnetic resonance imaging (MRI) revealed the neurohypophyseal T1-bright spot situated ectopically, with a normal adenohypophysis and infundibulum. She remains clinically well, currently breastfeeding, and off all medication. This case illustrates some challenges in the diagnosis and management of transient gestational DI.
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Affiliation(s)
- Pedro Marques
- Endocrinology Department , Instituto Português de Oncologia de Lisboa , Francisco Gentil, Rua Professor Lima Basto1099-023, Lisboa , Portugal ; Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford , Oxford , UK
| | - Kavinga Gunawardana
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford , Oxford , UK
| | - Ashley Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford , Oxford , UK
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10
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Bellastella G, Bizzarro A, Aitella E, Barrasso M, Cozzolino D, Di Martino S, Esposito K, De Bellis A. Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases. Eur J Endocrinol 2015; 172:K11-7. [PMID: 25501964 DOI: 10.1530/eje-14-0762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, an increased incidence of central diabetes insipidus (CDI) in pregnancy, and less frequently in the post partum period, has been reported, most probably favoured by some conditions occurring in pregnancy. This study was aimed at investigating the influence of pregnancy on a pre-existing potential/subclinical hypothalamic autoimmunity. We studied the longitudinal behaviour of arginine-vasopressin cell antibodies (AVPcAbs) and post-pituitary function in two young women with a positive history of autoimmune disease and presence of AVPcAbs, but without clinical CDI, and who became pregnant 5 and 7 months after our first observation. The behaviour of post-pituitary function and AVPcAbs (by immunofluorescence) was evaluated at baseline, during pregnancy and for 2 years after delivery. AVPcAbs, present at low/middle titres at baseline in both patients, showed a titre increase during pregnancy in one patient and after delivery in the other patient, with development of clinically overt CDI. Therapy with 1-deamino-8-d-arginine vasopressin (DDAVP) caused a prompt clinical remission. After a first unsuccessful attempt of withdrawal, the therapy was definitively stopped at the 6th and the 7th month of post partum period respectively, when AVPcAbs disappeared, accompanied by post-pituitary function recovery, persisting until the end of the follow-up. The determination of AVPcAbs is advisable in patients with autoimmune diseases planning their pregnancy, because they could be considered good predictive markers of gestational or post partum autoimmune CDI. The monitoring of AVPcAb titres and post-pituitary function during pregnancy in these patients may allow for an early diagnosis and an early replacement therapy, which could induce the disappearance of these antibodies with consequent complete remission of CDI.
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Affiliation(s)
- Giuseppe Bellastella
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Antonio Bizzarro
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Ernesto Aitella
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Mariluce Barrasso
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Domenico Cozzolino
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Sergio Di Martino
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Katherine Esposito
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
| | - Annamaria De Bellis
- Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy
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11
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Ko JK, Shek NW, Lee CP. Transient diabetes insipidus with severe maternal and fetal hypernatremia. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Diabetes insipidus is a condition characterised by polyuria and polydipsia with excretion of diluted urine. Transient diabetes insipidus has been reported in pregnancy and is often associated with acute fatty liver of pregnancy, pre-eclampsia, HELLP syndrome and multiple pregnancy. Presenting symptoms can be vague. In our case, a primigravida with spontaneous monochorionic diamniotic twin pregnancy presented at 36+3 weeks in early labour. Severe hypernatremia was found in the patient and in both twins after a caesarean section was performed. Transient diabetes insipidus was diagnosed based on paired serum and urine osmolality. The hypernatremia was corrected gradually and 1-deamino-8D-arginine vasopressin was given. A high index of suspicion and early involvement of physicians and paediatricians are needed to avoid catastrophic consequences.
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Affiliation(s)
- Jennifer K.Y. Ko
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Noel W.M. Shek
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Chin Peng Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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12
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Renard MC, Chillarón JJ, Flores-Le-Roux JA. Panhypopituitarism in a pregnant women caused by a cystic sellar lesion. Endocrine 2014; 46:166-8. [PMID: 23963812 DOI: 10.1007/s12020-013-0037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Affiliation(s)
- M C Renard
- Department of Endocrinology, Hospital Del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
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13
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De Mesmay M, Rigouzzo A, Bui T, Louvet N, Constant I. [Gestational diabetes insipidus during a twin pregnancy]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2013; 32:118-121. [PMID: 23380272 DOI: 10.1016/j.annfar.2012.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/11/2012] [Indexed: 06/01/2023]
Abstract
Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.
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Affiliation(s)
- M De Mesmay
- Service d'anesthésie-réanimation chirurgicale, hôpital Armand-Trousseau, APHP, UPMC, 26, rue du Docteur-Arnold-Netter, 75012 Paris cedex 12, France
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14
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Aragón-Charris J, Reyna-Villasmil E, De Nobrega-Correa H, Torres-Cepeda D. [Diabetes insipidus induced by pregnancy. A case report]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2013; 60:105-106. [PMID: 22520166 DOI: 10.1016/j.endonu.2012.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/10/2012] [Accepted: 01/16/2012] [Indexed: 05/31/2023]
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Bellastella A, Bizzarro A, Colella C, Bellastella G, Sinisi AA, De Bellis A. Subclinical diabetes insipidus. Best Pract Res Clin Endocrinol Metab 2012; 26:471-83. [PMID: 22863389 DOI: 10.1016/j.beem.2011.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Subclinical central diabetes insipidus (CDI) can be the outcome of a number of diseases that affect the hypothalamus-infundibulum-post hypophysis axis. One of the most common forms of subclinical CDI is linked to an autoimmune pathogenesis even if other causes may be also responsible. Among these, pregnancy, traumatic and surgical brain injury and some infiltrative, vascular, infectious and neoplastic diseases have been reported with increasing frequency. The natural history of autoimmune CDI seems to evolve through 4 functional stages according to the presence of antibodies to vasopressin-secreting cells (AVPcAb) and the relationship between their behavior overtime, the variations of posterior pituitary function and the characteristics of hypothalamic-hypophyseal region on magnetic resonance imaging. This staging is of crucial importance for the therapeutic strategy, taking into account that some stages could be still reversible. Several medical treatments have been suggested to interrupt the progression toward clinical CDI but the results are still discussed.
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Affiliation(s)
- Antonio Bellastella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Via Leonardo Bianchi, Monaldi Hospital, 80131 Naples, Italy
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16
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Karaca Z, Kelestimur F. Pregnancy and other pituitary disorders (including GH deficiency). Best Pract Res Clin Endocrinol Metab 2011; 25:897-910. [PMID: 22115165 DOI: 10.1016/j.beem.2011.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The pituitary gland is one of the most affected organs with altered anatomy and physiology during pregnancy. Acromegaly is the second most common pituitary adenoma seen in relation to gestation after prolactinomas. Acromegaly should be treated before conception to prevent potential tumor growth in patients who desire fertility. Medical therapy can be ceased safely after confirmation of pregnancy in acromegalic patients, but octreotide may be used in selected cases with compressive signs. Other hormonal and non-functional tumors are rarer and have been presented as case reports. Sheehan's syndrome, which is one of the most common causes of hypopituitarism in developing countries, and lymphocytic hypophysitis are known to be associated with pregnancy. They usually result in hypopituitarism, sometimes with delays in diagnosis and difficulties in differential diagnosis. Pregnancy is not common among patients with hypopituitarism or pituitary adenomas due to altered gonadotroph functions. Ovulation induction is essential for fertility achievement, but the replacement of other deficient pituitary hormones, including GH, seems to play an important role in the preparation of the uterus for implantation of the embryo.
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Affiliation(s)
- Zuleyha Karaca
- Erciyes University Medical School, Department of Endocrinology, Kayseri, Turkey.
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17
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Abstract
Diabetes insipidus (DI) is a rare disorder of horses characterized by profound polyuria and polydipsia (PU/PD), which can be caused by loss of production of arginine vasopressin (AVP). This condition is termed neurogenic or central DI. DI may also develop with absence or loss of AVP receptors or activity on the basolateral membrane of collecting-duct epithelial cells. This condition is termed nephrogenic DI. Equine clinicians may differentiate true DI from more common causes of PU/PD by a systematic diagnostic approach. DI may not be a correctable disorder, and supportive care of affected horses requires an adequate water source.
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18
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Severe Hydramnios and Preterm Delivery in Association With Transient Maternal Diabetes Insipidus. Obstet Gynecol 2010; 116 Suppl 2:547-549. [DOI: 10.1097/aog.0b013e3181e6c683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Aleksandrov N, Audibert F, Bedard MJ, Mahone M, Goffinet F, Kadoch IJ. Gestational Diabetes Insipidus: A Review of an Underdiagnosed Condition. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:225-31. [DOI: 10.1016/s1701-2163(16)34448-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Krysiak R, Kobielusz-Gembala I, Okopien B. Recurrent pregnancy-induced diabetes insipidus in a woman with hemochromatosis. Endocr J 2010; 57:1023-8. [PMID: 20953066 DOI: 10.1507/endocrj.k10e-125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diabetes insipidus is a rare disorder in pregnant women, predating pregnancy or appearing for the first time during gestation. In pregnancy it usually affects women with HELLP syndrome or acute fatty liver of pregnancy and results from the reduced hepatic degradation of placental vasopressinase leading to its increased activity. Although infiltrative diseases have been found to cause diabetes insipidus in non-pregnant population, very few studies showed that these disorders may manifest for the first time during gestation. We describe here the case of transient diabetes insipidus in two subsequent pregnancies of a female with hemochromatosis. The first symptoms of this disease appeared for the first time at the beginning of the third trimester of her second pregnancy, and diagnosis was established on the basis of typical clinical presentation, confirmed by a water deprivation test. Diabetes insipidus resulted from the increased activity of vasopressinase, caused by hemochromatosis-induced liver dysfunction, the presence of which was confirmed between the pregnancies by liver biopsy and identification of the HFE gene mutation. Subsequent desferrioxamine treatment resulted in a less severe clinical course of diabetes insipidus in the last patient's pregnancy. In both pregnancies, the patient was successfully treated with oral desmopressin, which is resistant to degradation by placental vasopressinase. Although unrecognized pituitary disorders may pose a serious health problem to the mother and fetus, hemochromatosis-induced diabetes insipidus, as the case of our patient demonstrates, if effectively diagnosed and treated, cannot be regarded as a contraindication for pregnancy.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
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Diabetes insípida asociada a preeclampsia grave. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wiser A, Hershko-Klement A, Fishman A, Nachasch N, Fejgin M. Gestational diabetes insipidus and intrauterine fetal death of monochorionic twins. J Perinatol 2008; 28:712-4. [PMID: 18825149 DOI: 10.1038/jp.2008.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gestational diabetes insipidus (GDI) is a rare disorder. The onset is usually in the third trimester of pregnancy. We present a 24-year-old primigravida in her 35th week of a monochorionic-diamniotic twin pregnancy. The patient presented with intrauterine death of both twins accompanied by HELLP syndrome, hypernatremia and hemoconcentration. Urine osmolality below that of the plasma suggested GDI. 1-deamino-8D-arginine vasopressin (dDAVP) treatment was started with a quick response. GDI is probably the result of excessive activity of placental vasopressinase. In cases of liver dysfunction, the clearance rate of vasopressinase decreases, explaining the association of GDI with acute fatty liver and HELLP syndrome. Alert to this diagnosis, its evaluation and treatment is important.
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Affiliation(s)
- A Wiser
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Sava,, Israel.
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Renneboog B, Decaux G. Idiopathic hyponatremia in a young patient: look at the sinus. Am J Med 2008; 121:e5-6. [PMID: 18456021 DOI: 10.1016/j.amjmed.2008.01.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 12/17/2007] [Accepted: 01/08/2008] [Indexed: 11/18/2022]
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