Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis. Issue 3 (15th March 2021)

• Record Type: Journal Article
• Authors: Araújo, Alexandra Novais; Cunha, Maria; Marques, Tiago; Bugalho, Maria João Guerreiro Martins
• Is Part Of: BMJ case reports. Volume 14:Issue 3(2021)
• Publication Date: 2021-03-15
• Subjects: HIV / AIDS -- pregnancy -- fluid electrolyte and acid-base disturbances -- drugs: endocrine system; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-238410
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Diabetes insipidus (DI) is characterised by thirst and polydipsia with hypotonic polyuria. Several forms exist, namely, central or pituitary, nephrogenic and gestational and must be differentiated for adequate treatment. We describe the case of a 41-year-old woman chronically infected with HIV who had been recently medicated with a tenofovir-based antiretroviral treatment and who, at 22 weeks of pregnancy, presented with transient gestational DI. Obstetric ultrasound revealed oligohydramnios and foetal growth restriction that did not improve despite serum sodium correction. The severity of the case suggested the presence of an underlying disorder and elevated copeptin levels indicated that an underlying subclinical form of nephrogenic DI, possibly induced by HIV-related nephropathy or tenofovir use, was present and rendered clinically overt during pregnancy.