A Case of Central Diabetes Insipidus: Evaluation in Pregnancy
ABSTRACT
A 20 years old woman, admitted in our Centre at the 6th week of pregnancy, was affected by Central Diabetes Insipidus and since the age of 10 years old she assumed desmopressin at a dose of 30mg/nostril/day. She was primigravida, with normal past medical history. Fasting blood levels were normal; specific gravity of the urine: 1006; no glucosuria or proteinuria was present. Urinary and plasma osmolality were 245 and 287 mOsm/l; water intake about 2700mL/day; diuresis 2000mL/day. On the basis of the value of urine output and osmolality the dose of desmopressin was Increased at 40 mg/nostril/day. Patient was evaluated every month with fluid balance, urine volume, osmolality, and serum electrolytes. Daily dosage of desmopressin was 40mg/nostril for all the duration of pregnancy according to a trend of an adequate fluid and electrolytes balance and in absence of symptoms. Mean blood Pressure was 100/60 mmHg; coagulation, liver, renal function were normal. Fetal monitoring with periodic ultrasound detected a normal intrauterine growth. Patient had an uncomplicated labor of a healthy male baby at the 39th week. Because of an insufficient dilatation of the cervical canal caesarian section was chosen. Despite a previous Central Diabetes Insipidus may worsen in a pregnant with impaired reserve of Antidiuretic Hormone because of the changes in osmoregulatory system and increased levels of vasopressinasis in middle and late pregnancy, our patient required a slightly higher dose of desmopressin in the first trimester. Contrary to expectations the need of desmopressin did not increase during the weeks.
A 20 years old woman, admitted in our Centre at the 6th week of pregnancy, was affected by Central Diabetes Insipidus and since the age of 10 years old she assumed desmopressin at a dose of 30mg/nostril/day. She was primigravida, with normal past medical history. Fasting blood levels were normal; specific gravity of the urine: 1006; no glucosuria or proteinuria was present. Urinary and plasma osmolality were 245 and 287 mOsm/l; water intake about 2700mL/day; diuresis 2000mL/day. On the basis of the value of urine output and osmolality the dose of desmopressin was Increased at 40 mg/nostril/day. Patient was evaluated every month with fluid balance, urine volume, osmolality, and serum electrolytes. Daily dosage of desmopressin was 40mg/nostril for all the duration of pregnancy according to a trend of an adequate fluid and electrolytes balance and in absence of symptoms. Mean blood Pressure was 100/60 mmHg; coagulation, liver, renal function were normal. Fetal monitoring with periodic ultrasound detected a normal intrauterine growth. Patient had an uncomplicated labor of a healthy male baby at the 39th week. Because of an insufficient dilatation of the cervical canal caesarian section was chosen. Despite a previous Central Diabetes Insipidus may worsen in a pregnant with impaired reserve of Antidiuretic Hormone because of the changes in osmoregulatory system and increased levels of vasopressinasis in middle and late pregnancy, our patient required a slightly higher dose of desmopressin in the first trimester. Contrary to expectations the need of desmopressin did not increase during the weeks.
Cite this paper
nullP. Gargiulo, N. Mecca, V. Mercuri and T. D’Amico, "A Case of Central Diabetes Insipidus: Evaluation in Pregnancy," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 278-280. doi: 10.4236/ijcm.2011.23045.
nullP. Gargiulo, N. Mecca, V. Mercuri and T. D’Amico, "A Case of Central Diabetes Insipidus: Evaluation in Pregnancy," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 278-280. doi: 10.4236/ijcm.2011.23045.
References
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[1] Hime MC, Richardson JC. Diabetes insipidus and pregnancy: case report, incidence and review of literature. Obstet gnecol Surv 1978; 3: 37 [2] Sonia Ananthakrishnan,MD. Diabetes insipidus in pregnancy: etiology, evaluation and management. Endocr Pract. 2009; 15: 4 [3] Robert W Schrier. Systemic Arterial Vasodilatation, Vasopressin, and Vasopresinase in Pregnancy. J.Am. Soc of Neph. 2010. 21: 570-572 [4] DavisonJM, Sheills EA, Phillips PR, Lindheimer MD. Serial evaluation of vasopressin release and thirst in human pregnancy. Role of human chorionic gonadotrophin in the osmoregulatory changes of gestation. J Clin. Invest.1988; 81:798-806 [5] Davison JM. Gilmore EA, Dürr J, Robertson GL, Lindheimer MD. Altered osmotic thresholds for vasopressin secretion and thirst in human pregnancy. Am J Physiol. 1984; 246: F105-F109. [6] Lindheimer MD, Barron WM, Davison JM. Osmoregulation of thirst and vasopressin release in pregnancy [erratum in Am J Physiol. 1989; 257: preceding F503]. Am J Physiol. 1989; 257: F159-F169 [7] Lindheimer MD. Polyuria and pregnancy: its cause, its danger. Obstet Gynecol. 2005; 105: 1171-1172. [8] Davison JM, Sheills EA, Philips PR, Barron WM, Lindheimer MD. Metabolic clearance of vasopressin and an analogue resistant to vasopressinase in human pregnancy. Am J Physiol. 1993; 264: F348-F353. [9] Iwasaki Y, Oiso Y, Kondo K, et al. Aggravation of subclinical diabetes insipidus during pregnancy. N Engl J Med. 1991; 324: 522-526. [10] Hamai Y, Fujuu T, Nishina H, Kozuma S, Yoshikawa H,.Taketani Y (1997) Differential clinical course of preg- nancies complicated by diabetes insipidus which does, or does not pre-date the pregnancy. Hum Reprod 2: 1816- 1818. [11] Dürr JA. Diabetes insipidus in pregnancy. Am J Kidney Dis.1987; 9: 276-283. [12] Brewster UC, Hayslett JP. Diabetes insipidus in the third trimester of pregnancy. Obste Gynecol 2005; 105: 1173- 1176-1173-1176. [13] K?llén BA, Carlsson SS, Bengtsson BK. Diabetes insipidus and use of desmopressin (Minirin) during pregnancy. Eur J Endocrinol. 1995; 132: 144-146. [14] Ray JG. DDAVP use during pregnancy: an analysis of its safety for mother and child. Obstet Gynecol Surv. 1998; 53: 450-455. [15] Hjartardottir S, Leifsson BG, Geirsson RT, Steinthorsdottir V. Paternity change and the recurrence risk in familial hypertensive disorder in pregnancy. Hypertens Pregnancy. 2004; 23: 219-225. [16] Yamanaka Y, Takeuchi K, Konda E, Samoto T, Satou A, Mizudori M, Maruo T (2002) Transient postpartum diabetes insipidus in twin pregnancy associated with HELLP syndrome. J Perinat Med 30(3): 273-275. [17] Kalelioglu I, Kubat Uzum A, Yildirim A, Okzam T. Transient gestational diabetes insipidus diagnosed in successive pregnancies: review of pathophysiology, diagnosis, treatment, and management of delivery. Pituitary 2007. 10: 87-93