2021 Volume 57 Issue 2 Pages 390-394
【Case】
A 37-year-old multiparous pregnant woman was taken regular pregnancy checkups at maternity clinic. Pregnancy course was uneventful, but ritodrine chloride tablet was administered after 30 weeks of gestation due to small uterine contraction. She was followed up for her thirst, malaise, polyuria, nocturia and polydipsia at this clinic form 32 weeks of gestation. However, she was transferred to our perinatal center at 35 weeks of gestation due to develop hepatic and renal dysfunction. Physical findings were as follows: clear consciousness, afebrile, pulse 98/min, blood pressure 123/97mmHg, soft abdomen, no tenderness, estimated fetal body weight 2,380g（-0.4SD）, amniotic fluid pocket 2.1cm. Laboratory data were as follows: Platelets 160,000/μL, AST 347U/L, ALT 397U/L, ALP 654U/L, LDH 595U/L, γGTP 34U/L, Creatinine 1.03mg/dL, UA 9.0mg/dL, plasma osmolality 301 mOsm/kg, urine osmolality 126 mOsm/kg. Abdominal ultrasound did not reveal fatty liver. Head MRI was taken due to suspicious of diabetes insipidus and high signal loss in the posterior pituitary was observed in T1-weighted image. Therefore, diagnosis of transient diabetes insipidus was made and desmopressin was administered. Despite desmopressin administration, amniotic fluid decreased to none and hepatic dysfunction worsened. We decided termination of pregnancy. After delivery, symptoms, and hepatic and renal dysfunction was improved and head MRI revealed improved high signal in posterior pituitary. She no longer needed desmopressin and discharged 6th day after delivery.
【Conclusion】
The mechanism of the onset of transient diabetes insipidus is considered that the metabolism of vasopressinase （ADHase）in the liver is lowered due to some preceding hepatic dysfunction, the blood concentration of ADHase is increased, and vasopressin is decomposed, or that ADHase is increased by increased placental weight due to multiple pregnancies. In this case, there was little improvement with desmopressin and worsening of liver dysfunction due to dehydration, so we chose to terminate the pregnancy to reduce maternal distress.
