deamino-arginine-vasopressin and Diabetes--Gestational

To review the etiology, diagnosis, and management of diabetes insipidus during pregnancy.. A search of the literature was performed in PubMed using key word searching and citation snowballing to identify articles published in English between January 1, 1980, and December 31, 2008, on the subject of diabetes insipidus during pregnancy. Once the articles were identified, a thorough review of all results was conducted. Results and conclusions were compiled and summarized.. We reviewed 50 studies selected using the following key words: diabetes insipidus, pregnancy, arginine vasopressin, vasopressinase.. Gestational diabetes insipidus is underdiagnosed because polyuria is often considered normal during pregnancy. Clinicians caring for pregnant women should consider screening for gestational diabetes insipidus, because it could be associated with serious underlying pathology.

Topics: Antidiuretic Agents; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Diuretics; Female; Humans; Hydrochlorothiazide; Magnetic Resonance Imaging; Pituitary Gland, Posterior; Pregnancy; Puerperal Disorders; Ultrasonography, Prenatal; Vasopressins

Gestational diabetes insipidus (GDI) is a rare disorder characterised by polyuria, polydypsia, and excessive thirst usually manifesting in the third trimester of pregnancy. The etiology is thought to depend on excessive vasopressinase activity, a placental enzyme that degrades arginine-vasopressin (AVP), but not 1-deamino-8-D: -arginine vasopressin (dDAVP), which is a synthetic form. This is a transient syndrome and may be associated with acute fatty liver of pregnancy and preeclampsia. The use of dDAVP in symptomatic cases has been proven as a safe method for both the mother and the fetus during the pregnancy. We report a case of recurrent gestational diabetes insipidus in successive pregnancies, which responded to dDAVP and subsided after delivery.

Topics: Adult; Cesarean Section, Repeat; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Magnetic Resonance Imaging; Pregnancy

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Fetal Death; Humans; Liver Function Tests; Pregnancy

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.

Topics: Adult; Anesthesia, Obstetrical; Blood Glucose; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; HELLP Syndrome; Humans; Hypoglycemic Agents; Infant, Newborn; Pregnancy; Pregnancy, Twin

We report a case of eclampsia in a twin pregnancy complicated by HELLP syndrome and diabetes insipidus. This confluence of disease processes suggests that a modification of common magnesium sulfate treatment protocols may be appropriate in a certain subset of patients.

Topics: Adolescent; Anticonvulsants; Antidiuretic Agents; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Eclampsia; Female; HELLP Syndrome; Humans; Magnesium Sulfate; Pregnancy; Twins

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.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Pregnancy; Pregnancy Complications; Renal Agents; Urination

We present six cases of diabetes insipidus (DI) complicating pregnancy. In three cases, DI was manifested during pregnancy and required the administration of desmopressin acetate (1-desamino-8-D-arginine vasopressin, DDAVP). All these cases exhibited abnormal laboratory data such as an elevation of liver enzymes or a decrease in serum antithrombin III. The remaining three cases had suffered from DI before pregnancy which was well controlled on DDAVP. The clinical courses of these pregnancies were all uneventful subsequent to therapy. If DI is first recognized during pregnancy, attention should be paid to the possibility of abnormal liver function and eclampsia.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Hypoglycemic Agents; Liver; Pregnancy; Pregnancy in Diabetics

Two pregnant women developed overt polyuria (up to 11 l/day) and polydipsia during their second and third trimesters of pregnancy. In one patient hydronephrosis was present. Both patients suffered from mild gestational diabetes mellitus. Plasma sodium was 145 and 162 mmol/l. Polyuria and urinary hypo-osmolality responded well to desmopressin acetate. After delivery, polyuria and polydipsia disappeared in one patient and significantly improved in the other. Infusion of hypertonic saline one and two weeks respectively after delivery led to plasma hyper-osmolality (294 mosmol/kg and 305 mosmol/kg) without detectable stimulation of arginine vasopressin (AVP). Anterior pituitary function was normal. No stimulation of AVP occurred following insulin-induced hypoglycemia. AVP plasma disappearance after i.v. pulse injection of 1 microgram AVP as well as AVP plasma concentration after continuous infusion of 10 ng AVP/min was studied two weeks after delivery in one patient. The results suggested markedly elevated degradation of AVP compared to control subjects, probably due to an increased vasopressin activity. Eight months after delivery, hypertonic saline infusion in one patient led to a plasma-osmolality of 312 mosmol/kg without stimulation of AVP. In the second patient, AVP was not detectable (less than 0.2 pg/ml) six months after delivery when plasma osmolality was 290 mosmol/kg. Our studies demonstrate that a subclinical compensated diabetes insipidus was preexistent in both patients. Exacerbation occurred due to an increased AVP-clearance and presumably due to the hemodynamic and hormonal alterations during pregnancy, including a mild gestational diabetes mellitus.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Polyuria; Pregnancy; Pregnancy Complications; Sodium