Transient postpartum diabetes insipidus in twin pregnancy associated with HELLP syndrome

Abstract

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.

Usefulness of anti-rabphilin-3A antibodies for diagnosing central diabetes insipidus in the third trimester of pregnancy

“…Uterine contraction and lactation were normal. After delivery, diabetes insipidus continued, and treatment with desmopressin was continuously required, suggesting that polyuria was not mainly due to excessive vasopressinase activity or reduced renal sensitivity to AVP by PGE 2 that can cause temporal polyuria during pregnancy [4,5]. A follow-up MRI performed one month after delivery (Fig.…”

“…Increased vasopressinase activity was caused by the excessive production in the placenta, or the insufficient hepatic degradation due to transient liver dysfunction [4]. LINH causes central diabetes insipidus and swelling of posterior pituitary and/or stalk.…”

Pregnancy and pituitary disorders

“…Besides placental vasopressinase activity, transient liver dysfunction may decrease the degradation of vasopressinase in the liver. This may explain the association of acute fatty liver of pregnancy and HELLP syndrome (288)(289)(290)(291). Therefore, women developing DI late in gestation should be screened for liver function abnormalities.…”

Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

“…It can occur at any stage of gestation and more rarely after delivery (4,5). Various conditions occurring during pregnancy can favour the development of CDI, such as increased degradation of arginine vasopressin (AVP) by vasopressinase, a placental enzyme that cleaves AVP but not 1-deamino-8-D-AVP (DDAVP) (6,7,8,9). Moreover, some cases of CDI in pregnancy may be linked to lymphocytic hypophysitis (LYH), an organ-specific autoimmune disease of the pituitary gland, closely related to pregnancy and the post partum period (10), especially when the autoimmune inflammatory process involves the infundibulum and neurohypophysis, as occurs in lymphocytic infundibuloneurohypophysitis (11).…”