Transient gestational diabetes insipidus diagnosed in successive pregnancies: review of pathophysiology, diagnosis, treatment, and management of delivery

Abstract

Gestational diabetes insipidus (GDI) is a rare disorder characterised by polyuria, polydypsia, and excessive thirst usually manifesting in the third trimester of pregnancy. The etiology is thought to depend on excessive vasopressinase activity, a placental enzyme that degrades arginine-vasopressin (AVP), but not 1-deamino-8-D: -arginine vasopressin (dDAVP), which is a synthetic form. This is a transient syndrome and may be associated with acute fatty liver of pregnancy and preeclampsia. The use of dDAVP in symptomatic cases has been proven as a safe method for both the mother and the fetus during the pregnancy. We report a case of recurrent gestational diabetes insipidus in successive pregnancies, which responded to dDAVP and subsided after delivery.

Gestational diabetes insipidus and intrauterine fetal death of monochorionic twins

“…Diabetes insipidus is not a common endocrinopathy during pregnancy; its incidence is estimated to be four in 100 000. 1 During pregnancy, and in the absence of glycosuria, hypokalemia or hypercalcemia, DI can be established if a patient with a syndrome of polyuria-polydipsia has a serum osmolality >285 mOsm kg À1 . 4,5 Increased metabolic clearance rate of AVP because of the vasopressinase activity during pregnancy may lead to DI.…”

“…The onset is usually in the third trimester of pregnancy. 1 The etiology is probably excessive activity of placental vasopressinase, an enzyme synthesized by the placenta and degraded by the maternal liver. Vasopressinase can degrade arginine vasopresine (AVP), but not the synthetic analogue 1-deamino-8D-arginine vasopressin (dDAVP), with its different N-terminal.…”

Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

“…As a water deprivation test cannot be performed in pregnancy, a definite diagnosis of CDI was sought when a prompt decrease in oral fluid intake and urine output, and recovery of urinary osmolality to the normal range, was induced by DDAVP therapy (3,17).…”

En tvillinggravid kvinne med polyuri og polydipsi

“…Dette kan gjøres med en tørstetest, men er ikke anbefalt i svangerskapet pga. risiko for dehydrering (15). Pasientens symptomer forsvant få dager etter forløsning.…”