Transient diabetes insipidus in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Nephrology

Background:

• Gestational diabetes insipidus (DI) is a rare pregnancy complication, typically arising in the third trimester.
• It stems from excessive placental vasopressinase activity, which metabolizes arginine vasopressin (AVP).
• Diagnosis can be challenging, and treatment involves desmopressin.

Purpose of the Study:

• To present a case of gestational DI diagnosed and managed in late pregnancy.
• To highlight diagnostic and management challenges associated with this condition.
• To emphasize the importance of monitoring and timely intervention.

Main Methods:

• A case report of a 38-year-old woman presenting with polyuria, nocturia, and polydipsia in her third trimester.
• Laboratory investigations including serum and urine osmolality, serum electrolytes, and glucose levels.
• Treatment with desmopressin, followed by delivery and postpartum assessment.
• Pituitary MRI to rule out other pathologies.

Main Results:

• The patient exhibited low urine osmolality and normal serum osmolality, consistent with DI.
• Desmopressin treatment improved symptoms and normalized osmolality.
• Postpartum, desmopressin was discontinued, and symptoms resolved spontaneously.
• Pituitary MRI revealed an ectopic neurohypophyseal T1-bright spot.

Conclusions:

• Gestational DI is a rare condition linked to placental vasopressinase, often resolving postpartum.
• Accurate diagnosis requires careful assessment of osmolality and electrolyte balance.
• Desmopressin is effective for symptom management during pregnancy.
• Pituitary MRI is crucial for differential diagnosis.