title: Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases.
abstract: Recently, an increased incidence of central diabetes insipidus (CDI) in pregnancy, and less frequently in the post partum period, has been reported, most probably favoured by some conditions occurring in pregnancy. This study was aimed at investigating the influence of pregnancy on a pre-existing potential/subclinical hypothalamic autoimmunity. We studied the longitudinal behaviour of arginine-vasopressin cell antibodies (AVPcAbs) and post-pituitary function in two young women with a positive history of autoimmune disease and presence of AVPcAbs, but without clinical CDI, and who became pregnant 5 and 7 months after our first observation. The behaviour of post-pituitary function and AVPcAbs (by immunofluorescence) was evaluated at baseline, during pregnancy and for 2 years after delivery. AVPcAbs, present at low/middle titres at baseline in both patients, showed a titre increase during pregnancy in one patient and after delivery in the other patient, with development of clinically overt CDI. Therapy with 1-deamino-8-d-arginine vasopressin (DDAVP) caused a prompt clinical remission. After a first unsuccessful attempt of withdrawal, the therapy was definitively stopped at the 6th and the 7th month of post partum period respectively, when AVPcAbs disappeared, accompanied by post-pituitary function recovery, persisting until the end of the follow-up. The determination of AVPcAbs is advisable in patients with autoimmune diseases planning their pregnancy, because they could be considered good predictive markers of gestational or post partum autoimmune CDI. The monitoring of AVPcAb titres and post-pituitary function during pregnancy in these patients may allow for an early diagnosis and an early replacement therapy, which could induce the disappearance of these antibodies with consequent complete remission of CDI.
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellastella
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bizzarro
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Aitella
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Mariluce
authors.initials: M
authors.lastname: Barrasso
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Cozzolino
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Martino
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.affiliation: Departments of Medical, Surgical, Neurological, Metabolic and Geriatric SciencesClinical and Experimental MedicineCardiothoracic and Respiratory SciencesSecond University of Naples, Piazza L. Miraglia 2, 80131 Napoli, Italy annamaria.debellis@unina2.it.
authors.forename: Annamaria
authors.initials: A
authors.lastname: De Bellis
mesh_terms: D000328:Adult; D001127:Arginine Vasopressin / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D020790:Diabetes Insipidus, Neurogenic / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology*; D005260:Female; D006801:Humans; D011247:Pregnancy
chemical_list: D001323:Autoantibodies; D001127:Arginine Vasopressin; D003894:Deamino Arginine Vasopressin