1/62. 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.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/62. 'Stalkitis' in a pregnant 32-year-old woman: a rare cause of diabetes insipidus.A case of lymphocytic infundibulo-neurohypophysitis (LINH) or 'stalkitis' in a 32-year-old woman who presented with diabetes insipidus (DI) during pregnancy is reported here. The diagnosis was made with MR imaging. The clinical and radiological features of this rare disorder and the differential diagnosis of infundibular mass lesions are discussed. The differentiation from lymphocytic adenohypophysitis (LAH) is made. No improvement of the DI accompanying LINH is achieved with trans-sphenoidal surgery. Hence, recognition of typical cases with MR imaging and appropriate medical management avoids unnecessary neurosurgery. This is the second reported case of LINH associated with pregnancy and may suggest an association.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
3/62. Infundibulohypophysitis in a man presenting with diabetes insipidus and cavernous sinus involvement.Infundibulohypophysitis is an unusual inflammatory condition that affects the infundibulum, the pituitary stalk, and the neurohypophysis and may be part of a range that includes lymphocytic hypophysitis. Lymphocytic hypophysitis occurs mainly in women and most often presents in the later stages of pregnancy. Infundibulohypophysitis usually presents with diabetes insipidus and the cause remains unclear. The case of a 46 year old man with a 12 week history of polyuria and polydipsia is reported. Cranial diabetes insipidus was diagnosed on the basis of a water deprivation test. Initial cranial and pituitary imaging studies were normal. He subsequently developed symptoms of panhypopituitism over a period of 6-9 months and then, more acutely, developed diplopia secondary to a fourth nerve palsy. Further brain imaging studies disclosed an enhancing pituitary stalk and a left cavernous sinus lesion. An initial trial of immunosuppressive treatment did not help symptoms significantly. The diagnosis of infundibulohypophysitis was made on histological evidence. The patient was treated with prednisolone and methotrexate. At 9 months he is well, without symptoms, and the radiological abnormalities have resolved.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
4/62. Case report and review of the perinatal implications of maternal lithium use.The purpose of this study was to review the use of lithium in pregnancy and its effects on the neonate. This was a case study and review of the published literature.lithium is commonly used in the treatment of psychiatric disorders, specifically bipolar depression. Bipolar disorders that require treatment with lithium demand special consideration when the woman becomes pregnant. Reported neonatal problems with maternal lithium therapy include Ebstein's anomaly, poor respiratory effort and cyanosis, rhythm disturbances, nephrogenic diabetes insipidus, thyroid dysfunction, hypoglycemia, hypotonia and lethargy, hyperbilirubinemia, and large-for-gestational-age infants.lithium can have adverse effects on the fetus and newborn infant, but data suggest normal behavioral patterns in childhood.- - - - - - - - - - ranking = 0.54811903574361keywords = pregnancy, gestation (Clic here for more details about this article) |
5/62. Transient postpartum diabetes insipidus in twin pregnancy associated with hellp syndrome.diabetes insipidus during pregnancy is an uncommon medical problem, and its cause is not entirely clear. We present a woman with twin pregnancy associated with hellp syndrome, who developed diabetes insipidus during postpartum period. A hypertonic saline infusion study with measurement of plasma arginine vasopressin concentrations confirmed the diagnosis. She had mild response to 1-desamino-8-d-arginine-vasopressin (dDAVP) during the immediate postpartum period. On the 3rd postpartum day two doses of 100 microliters of dDAVP were administered, and her urinary volume gradually decreased. We could stop dDAVP on the 30th postpartum day. This exacerbation may result from increased vasopressinase activity caused by the excessive production in the placenta due to twin pregnancy, together with the insufficient degradation in the liver due to hellp syndrome.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
6/62. Complete Wolfram's syndrome and successful pregnancy.A case of successful pregnancy in a patient with complete Wolfram's syndrome is described. The diagnosis of diabetes insipidus (DI) was made during the pregnancy. The patient was the product of a consanguineous marriage. Our case is the fifth report of successful pregnancy; we underlined the importance of DI for its involvement with pregnancy.- - - - - - - - - - ranking = 4keywords = pregnancy (Clic here for more details about this article) |
7/62. Severe hypernatremia after cesarean delivery secondary to transient diabetes insipidus of pregnancy.BACKGROUND: Transient diabetes insipidus is an uncommon complication of pregnancy, usually manifesting with polydipsia and polyuria. This condition is considered to result from excess placental vasopressinase activity and is managed with deamino D arginine vasopressin. CASE: While on restricted oral intake after cesarean delivery, the patient gradually became disoriented and agitated in conjunction with markedly increased urine output disproportional to her intravenous crystalloid fluid intake. Marked hypernatremia of 178 mEq/dL was noted. urine osmolality was low at 248 mOsm/L. The clinical presentation and electrolyte abnormalities were considered consistent with transient diabetes insipidus of pregnancy. The patient responded well to nasal-spray-administered deamino D arginine vasopressin and increased intravenous fluid intake, with resolution of symptoms and gradual normalization of serum sodium levels. CONCLUSION: Transient diabetes insipidus of pregnancy should be considered in the differential diagnosis of severe hypernatremia in obstetric patients with restricted oral intake after operative delivery.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
8/62. Successful twin pregnancy in panhypopituitarism caused by suprasellar germinoma.BACKGROUND: pregnancy in a woman with hypopituitarism from a suprasellar germinoma is rare. CASE: A 27-year-old woman presented with panhypopituitarism from a suprasellar germinoma. She had diabetes insipidus, hypothyroidism, adrenal cortex dysfunction, and hypogonadotropic ovarian failure. When treated with thyroxin, cortisol, antidiuretic hormone, human menopausal gonadotropin, and human chorionic gonadotropin, she conceived and gave birth to healthy twins. CONCLUSION: Hormonal replacement therapy and ovulation induction resulted in a successful pregnancy in a woman with panhypopituitarism.- - - - - - - - - - ranking = 2.5keywords = pregnancy (Clic here for more details about this article) |
9/62. Transient gestational diabetes insipidus: report of two cases and review of pathophysiology and treatment.Gestational diabetes insipidus is a rare disorder characterized by polyuria and polydipsia due to the inability of the kidneys to concentrate urine. We report two cases of transient gestational diabetes insipidus in which patients responded to intranasal DDAVP (1-deamino-8-D-arginine vasopressin) with greater than 50% increase in urine osmolality and marked reduction in urine output. Intranasal DDAVP was discontinued after their discharge and both patients maintained normal urine output and appropriate urine osmolality. In determining whether diabetes insipidus is present in a patient who is polyuric and hypernatremic, a urine osmolality below that of the plasma suggests the presence of diabetes insipidus. Understanding of the pathophysiology may soon lead to improved methods of prevention, diagnosis and treatment.- - - - - - - - - - ranking = 0.24059517871807keywords = gestation (Clic here for more details about this article) |
10/62. Three cases of diabetes insipidus complicating pregnancy.diabetes insipidus (DI) is a rare complication of pregnancy. In cases related to pregnancy, the condition is thought to result from enhanced placental clearance of arginine vasopressin secondary to placental vasopressinase production. In such cases careful monitoring of the patient's fluid balance during and after pregnancy is essential. If treatment is necessary, desmopressin is the drug of choice. In the present article, we present three cases of pregnancy complicated by DI.- - - - - - - - - - ranking = 4keywords = pregnancy (Clic here for more details about this article) |
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