Pregnant woman with transient diabetes insipidus resistant to 1-desamino-8-D-arginine vasopressin.
We encountered a pregnant woman with transient diabetes insipidus which developed during the third trimester. A hypertonic saline infusion study did not concentrate the osmolality of urine. Her laboratory data showed hypokalemia, hyperreninemia, an increased concentration of plasma aldosterone and an increased urinary excretion rate of prostaglandin E2, which resembled hyperprostaglandin E-syndrome. T1-weighted magnetic resonance imaging of the posterior pituitary gland revealed decreased intensity. Polyuria reached 4-6 L daily, and urine osmolality remained dilute despite a lapse of four days since treatment with intranasal 1-desamino-8-D-arginine vasopressin (dDAVP: 10-25 microg every 12 h). The patient was conservatively managed without medical treatment, then delivered in the 38th week of pregnancy without complication. The osmolality of the patient's urine was higher than that of the plasma when tested 3 days postpartum. The abnormality of magnetic resonance imaging of the posterior pituitary gland disappeared at 6 months after delivery. We consider that subclinical nephrogenic diabetes insipidus in our patient was exacerbated during pregnancy.
Third Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan.
Y
Y
Jin-no
Y
Y
Kamiya
M
M
Okada
O
O
Watanabe
M
M
Ogasawara
T
T
Fujinami
D000328:Adult; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D003919:Diabetes Insipidus / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010902:Pituitary Gland / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D012076:Renal Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
D012076:Renal Agents; D003894:Deamino Arginine Vasopressin