Follow-up of gestational diabetes insipidus using magnetic resonance imaging

Quiroga, Borja; Viñuela, María Carmen; Benítez, Patrocinio Rodríguez; Pereda, A. Cardín; Navarro, T.; Aguarón, Ángel; Tejedor, Alberto

doi:10.1016/j.ejogrb.2012.02.022

Cited by 2 publications

(7 citation statements)

References 4 publications

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“…Three previous reports of GDI where MRI was obtained demonstrated absence of the physiological hyperintense signal in T1 of the posterior pituitary, reflecting reduced ADH storage. While the explanation for the disappearance of the signal in these cases of GDI is unclear, it has been suggested that it may be related to peripituitarial ADH depletion, as this is the theoretical first site of contact between vasopressinase and ADH . Alternatively, it may be postulated that cerebral vasoconstriction may lead to transient pituitary hypoperfusion resulting in diminished ADH production/secretion, which, when combined with vasopressinase‐induced ADH clearance, may exacerbate ADH deficiency in GDI.…”

Section: Discussionmentioning

confidence: 87%

“…13 However, MRA findings of cerebral vasoconstriction have also been described in pre-eclamptic patients with severe features without any neurologic symptoms, 14 as in the case of our patient. Three previous reports of GDI where MRI was obtained demonstrated absence of the physiological hyperintense signal in T1 of the posterior pituitary, [15][16][17] reflecting reduced ADH storage. While the explanation for the disappearance of the signal in these cases of GDI is unclear, it has been suggested that it may be related to peripituitarial ADH depletion, as this is the theoretical first site of contact between vasopressinase and ADH.…”

Section: Discussionmentioning

confidence: 99%

“…While the explanation for the disappearance of the signal in these cases of GDI is unclear, it has been suggested that it may be related to peripituitarial ADH depletion, as this is the theoretical first site of contact between vasopressinase and ADH. 16 Alternatively, it may be postulated that cerebral vasoconstriction may lead to transient pituitary hypoperfusion resulting in diminished ADH production/secretion, which, when combined with vasopressinase-induced ADH clearance, may exacerbate ADH deficiency in GDI. In both case reports, however, no abnormalities in the cerebral vasculature were mentioned, 15,16 although these may have been underdiagnosed, as plain MRI is not a sensitive diagnostic modality for their detection (which requires MRA).…”

Section: Discussionmentioning

confidence: 99%

“…16 Alternatively, it may be postulated that cerebral vasoconstriction may lead to transient pituitary hypoperfusion resulting in diminished ADH production/secretion, which, when combined with vasopressinase-induced ADH clearance, may exacerbate ADH deficiency in GDI. In both case reports, however, no abnormalities in the cerebral vasculature were mentioned, 15,16 although these may have been underdiagnosed, as plain MRI is not a sensitive diagnostic modality for their detection (which requires MRA). Future studies utilizing sensitive imaging modalities are warranted to characterize cerebral vascular changes in women with GDI and, if present, explore whether they may contribute to the pathophysiology of this syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Acute presentation of gestational diabetes insipidus with pre‐eclampsia complicated by cerebral vasoconstriction: A case report and review of the published work

Mor

Fuchs

Zafra

et al. 2015

J of Obstet and Gynaecol

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Gestational diabetes insipidus (GDI) is a rare, self-limited complication of pregnancy. As it is related to excess placental vasopressinase enzyme activity, which is metabolized in the liver, GDI is more common in pregnancies complicated by conditions associated with liver dysfunction. We present a case of a 41-year-old woman at 38 weeks' gestation who presented with pre-eclampsia with severe features, including impaired liver function and renal insufficiency. Following cesarean section she was diagnosed with GDI, which was further complicated by cerebral vasoconstriction as demonstrated by magnetic resonance angiography. This case raises the possibility that cerebral vasoconstriction may be related to the cause of GDI. A high index of suspicion of GDI should be maintained in patients who present with typical signs and symptoms, especially in the setting of pregnancy complications associated with liver dysfunction.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Acute presentation of gestational diabetes insipidus with pre‐eclampsia complicated by cerebral vasoconstriction: A case report and review of the published work

Mor

Fuchs

Zafra

et al. 2015

J of Obstet and Gynaecol

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“…In T1‐weighted MRI images, women with GDI also demonstrate an enlarged posterior pituitary, with absence of the normal physiological hyperintense signal. These changes resolve on postpartum rescanning (Figure ) …”

Section: The Link Between Pre‐eclampsia Hellp Syndrome and Gestationmentioning

confidence: 99%

Diabetes insipidus in pregnancy

Quigley

Shelton

Issa

et al. 2018

The Obstetric & Gynaecologis

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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.

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Follow-up of gestational diabetes insipidus using magnetic resonance imaging

Cited by 2 publications

References 4 publications

Acute presentation of gestational diabetes insipidus with pre‐eclampsia complicated by cerebral vasoconstriction: A case report and review of the published work

Acute presentation of gestational diabetes insipidus with pre‐eclampsia complicated by cerebral vasoconstriction: A case report and review of the published work

Diabetes insipidus in pregnancy

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