title: Postoperative diabetes insipidus associated with pituitary apoplexy during pregnancy.
abstract: BACKGROUND
  Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI).
  
  
  METHODS
  A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation.
  
  
  CONCLUSIONS
  Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion.
authors.affiliation: Department of Neurosurgery, Kanazawa University Hospital, Kanazawa, Japan. kitad@ns.m.kanazawa-u.ac.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kita
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sano
authors.forename: Toshinari
authors.initials: T
authors.lastname: Takamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Tachibana
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
mesh_terms: D000328:Adult; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D003919:Diabetes Insipidus / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D010899:Pituitary Apoplexy / Q000150:complications / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery
chemical_list: D003894:Deamino Arginine Vasopressin