Endocrine Abstracts

Introduction: Gestational diabetes insipidus (GDI) is a rare endocrinopathy whose incidence is around four cases per 100 000 pregnancies. It is a potentially life threatening state. We present a case of a 39 year old with GDI.

Case report: A previously healthy 39-year-old woman in her 37th week of gestation presented dry oral mucosa with polydipsia and polyuria of 8 l over 24 h for approximately 2 month. The prenatal course of the pregnancy was uncomplicated until 35 weeks. Medical history was an appendectomy and she had on treatment of female infertility with in vitro fertilisation. On admission, well general condition, blood pressure 105/60 mmHg and 75 beats/min and saturating 99% on ambient air. The physical and gynaecological examinations were unremarkable. Laboratory studies revealed: serum sodium of 140 mEq/l, potassium 4.3 mEq/l, chloride 108 mEq/l, glucose 79 mg/dl, creatinine 0.7 mg/dl, calcium 8.2 mEq/l, total protein 5.9 gm/dl, FA 142 units/l, AST 584 units/l, and ALT 613 units/l. The serum osmolality was 294 mOsm/kg; and urine osmolality was inappropriately low. Other laboratory datas were normal. Water deprivation test and treatment with DDAVP confirmed diagnosis. Twelve hours after admission, she had a female infant by spontaneous vaginal delivery with APGAR scores were 8, 10 at 5, and 10 min, respectively. Laboratory evaluation of the infant was normal. Post-delivery, polydypsia and polyuria were resolved. GDI was resolved after delivery.

Conclusions: The diagnosis of gestational DI is often not diagnosed because polyuria in pregnancy is generally considered normal. We should suspect in patients with typical symptoms or with risk factor because sometimes, GDI can be associated with serious pathology like fatty liver of pregnancy and pre-eclampsia that might lead to foetal demise.