A Case of Pregnancy Complicated by Diabetes Mellitus in Diabetes Insipidus Manifested during Late Pregnancy

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  • Fukuoka Yuki
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Narita Takuma
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Ogawa Masaki
    Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine
  • Sato Akira
    Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine
  • Terada Yukihiro
    Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine
  • Matsuda Akina
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Hoizumi Manabu
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Umetsu Kaori
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Sato Takehiro
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Ishikawa Motoko
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Hosoba Mihoko
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Morii Tsukasa
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Fujita Hiroki
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine
  • Yamada Yuichiro
    Department of Endocrinology and Diabetes and Geriatric Medicine, Akita University Graduate School of Medicine

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Other Title
  • 妊娠後期に尿崩症が顕在化した糖尿病合併妊娠の1例
  • 症例報告 妊娠後期に尿崩症が顕在化した糖尿病合併妊娠の1例
  • ショウレイ ホウコク ニンシン コウキ ニ ニョウホウショウ ガ ケンザイカ シタ トウニョウビョウ ガッペイ ニンシン ノ 1レイ

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Abstract

Diabetes insipidus complicating pregnancy is rare, occurring in 1 out of 40,000 to 300,000 pregnancies, so we report a thought-provoking case. A 35-year-old pregnant woman with polycystic ovary syndrome and diabetes mellitus developed thirst, polydipsia, and marked polyuria in gestational week 34. HbA1c (JDS) was maintained at 5-6 % with insulin treatment. Drink restriction only for 5 hours after breakfast increased serum sodium from 138 mEq/l to 144 mEq/l, and plasma osmolality exceeded urine osmolality of 213 mOsm/kg at 293 mOsm/kg. Plasma arginine vasopressin (AVP) was 0.9 pg/ml, without any increase. The woman was hospitalized for suspected central diabetes insipidus. Tentative intranasal desmopressin decreased urinary output to about 2 l/day. After delivery, desmopressin was discontinued. Urinary output returned to prepregnancy levels. Head magnetic resonance imaging (MRI) showed decreased high signal intensity in the posterior pituitary gland, and insufficient AVP increase was observed in a hypertonic saline loading test. Partial diabetes insipidus may have been partially manifested during late pregnancy, since increased AVP demand due to placental vasopressinase activity enhanced by pregnancy was not fully compensated for.<br>

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