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.     

Recurrent acute fatty liver of pregnancy

The first reported case of recurrent acute fatty liver of pregnancy confirmed by biopsy is described. In this case a high index of suspicion led to an early diagnosis and intervention with resultant improved maternal and fetal outcome. Electron microscopic examination of a liver biopsy specimen proved more beneficial in confirmation of the diagnosis compared with routine microscopic examination.     

Transient diabetes insipidus of pregnancy

The history is presented of a near-term patient with transient diabetes insipidus. Because of the demonstrated positive response to dDAVP it is argued that increased vasopressinase activity may have been involved.     

Transient diabetes insipidus of pregnancy

Transient diabetes insipidus (DI) is a disease of late pregnancy, that has been reported with increasing frequency. Although initially thought to be nephrogenic, the etiology of this syndrome is most likely excess vasopressinase activity. The disease is associated with preeclampsia with liver involvement. Infants of mothers with the syndrome are predominantly male. Management may be with deamino D arginine vasopressin (dDAVP) during gestation and postpartum since vasopressinase does not break down dDAVP. The copious urine output may disguise preeclampsia. Fluid restriction should be avoided as it will lead to dehydration and hemoconcentration.     

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.     

Diabetes insipidus and pregnancy. Case report, incidence and review of literature

The coexistence of diabetes insipidus (D.I.) and pregnancy is rare. Sixty-seven cases are reviewed, including one of our own. The condition tends to become worse in pregnancy, labor appears unaffected and lactation appears to lead to an improvement in D.I. Theories are discussed to account for the effect of pregnancy on D.I.     

妊娠急性脂肪肝患者的妊娠结局和随访分析

目的回顾性分析妊娠急性脂肪肝（acute fatty liver of pregnancy,AFLP）的临床特点,探讨早期诊断和治疗与妊娠结局及产后随访结局的关系。方法对5年内收治的6例AFLP患者的临床资料进行回顾性分析,并进行了1~5年的随访。结果临床表现有厌食、喜冷饮、恶心、呕吐、上腹不适、乏力及进行性加重的黄疸等。实验室检查肝转氨酶和血清胆红素升高、纤维蛋白原下降、凝血酶原时间延长。B超和CT显示脂肪肝影像。孕产妇并发症有低蛋白血症、肾功能损害、肝性脑病、低血糖等。发病至终止妊娠时间超过10d2例,其围产儿死亡,孕产妇病情危重。无孕产妇死亡病例发生。随访1～5年,产妇和存活的婴儿均健康,2例再次妊娠无再发病。结论掌握该病的临床特点,早期诊断、尽快终止妊娠及支持治疗,是提高母婴预后的关键,治愈后无远期不良结局。