Diabetes insipidus in pregnancy

Abstract

There are various types of diabetes insipidus that occur due to different pathology that occurs outside of, during, and as a result of pregnancy. All pregnant women presenting with polyuria and polydipsia should be investigated with blood tests including urea and electrolytes, calcium levels and thyroid function tests. Plasma and urine osmolality can also be helpful in making the diagnosis. Additional symptoms that are suggestive of diabetes insipidus secondary to other underlying pathology (e.g. a pituitary tumour) are likely to require radiological imaging. Women diagnosed with diabetes insipidus should have regular consultant review in clinic with monitoring of serum electrolytes. They should also receive an antenatal anaesthetic review. A multidisciplinary approach should be adopted during labour and they should be managed on delivery suite with senior obstetric and anaesthetic input. Pre-eclamptic toxaemia (PET) and haemolysis, elevated liver enzymes and low platelets (HELLP) can exacerbate diabetes insipidus as hepatic dysfunction leads to a reduction in vasopressinase metabolism. Furthermore, it has been suggested that pituitary hypoperfusion due to this syndrome could also be a cause of gestational diabetes insipidus. These women present a therapeutic challenge as they are in a volume-depleted state as a consequence of DI, however they require judicious fluid management because of their PET. Early detection and effective management will reduce morbidity and mortality in both the mother and fetus. Untreated or undiagnosed, it has the potential to have serious consequences for the expectant mother and fetus. Learning objectivesTo understand the different subtypes of diabetes insipidus, their pathophysiologies and their effects during the ante-, peri-and postnatal periods. To appreciate that diabetes insipidus can herald the onset of underlying hepatic dysfunction with associated serious maternal and fetal consequences arising from both the biochemical abnormalities associated with diabetes insipidus and the secondary problems of impaired liver function. To appraise the current theories of the link between PET and diabetes insipidus.

Клінічний Випадок Гестаційного Нецукрового Діабету

“…In pregnant women, some physiological processes make diagnosis of diabetes insipidus very difficult: thirst thre shold decreases leading to polydipsia and plasma osmolarity decreases causing hypotonic polyuria [5].…”

Diabetes Insipidus: Pathogenesis, Diagnosis, and Clinical Management

“…No gender difference has been reported for the autosomal dominant and recessive forms [ 2 , 10 , 11 ]. Interestingly, women who are pregnant with males are at a higher risk of developing gestational DI [ 39 ]. However, the main contributing factors leading to gestational DI are genetics combined with sedentary lifestyle factors.…”

Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

“…Therapy consists of the vasopression V2 receptor agonist desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP), usually administered intranasally in the evening. Dosages are usually higher than for non-pregnant patients 77 . After the patient has given birth, the administration of DDAVP to patients with transient diabetes insipidus can be discontinued after a few days or weeks; for patients with pre-existing disease, dosages should be reduced to the doses prescribed prior to pregnancy.…”

“…Die Therapie besteht in der Gabe des Vasopression-V 2 -Rezeptoragonisten Desmopressin (1-Desamino-8-D-Arginin-Vasopressin, DDAVP) meist abends intranasal, wobei die Dosis in der Regel höher ist als bei nicht schwangeren Patientinnen 77 . Nach der Geburt kann DDAVP bei transientem Diabetes insipidus innerhalb von Tagen bis Wochen abgesetzt werden, bei vorbestehender Erkrankung wird die Dosis wieder auf die Dosis vor der Schwangerschaft reduziert.…”