A Pregnant Woman with Excess Vasopressinase-Induced Diabetes Insipidus Complicated by Central Diabetes Insipidus like Lymphocytic Infundibulo-Neurohypophysitis

Figure 1

Clinical course of the patient. (a) Clinical course during the perinatal period. Around the end of 31 weeks of gestation, the patient suddenly presented with thirst, polydipsia, and polyuria and was referred to our endocrinology section at 34 weeks and one day of gestation. Although gestational diabetes insipidus was initially suspected, we closely monitored her clinical course without therapy. At 34 weeks and five days of gestation, because of the possible development of acute prerenal failure, an emergency cesarean section (CS) was performed, immediately followed by an initiation of intranasal administration of 1-desamino-8-D-arginine vasopressin (DDAVP). The patient’s daily urine volume promptly decreased, along with an increase in specific gravity. (b) Clinical course after delivery. This patient was once discharged on the 8th day postpartum and readmitted to our hospital for pituitary function evaluation, including a hypertonic saline infusion test, on the 25th day postpartum. Thus, no data for daily urine volume and urine-specific gravity from the 8–25th day postpartum were available (dotted line). Although the intranasal administration of DDAVP was discontinued on the 30th day postpartum, the patient remained DI-related symptom-free thereafter. The dotted bar and solid line represent daily urine volume and urine-specific gravity, respectively. CS: cesarean section; DDAVP: 1-desamino-8-d-arginine vasopressin; DI: diabetes insipidus; GWs: gestational weeks; MRI: magnetic resonance imaging (hypothalamic-pituitary region).

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