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Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis
  1. Alexandra Novais Araújo1,
  2. Maria Cunha2,
  3. Tiago Marques2 and
  4. Maria João Guerreiro Martins Bugalho1,3
  1. 1Hospital de Santa Maria, Serviço de Endocrinologia, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
  2. 2Hospital de Santa Maria, Serviço de Infecciologia, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
  3. 3Faculdade de Medicina Lisboa, Lisboa, Portugal
  1. Correspondence to Professor Maria João Guerreiro Martins Bugalho; maria.bugalho{at}chln.min-saude.pt

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.

  • HIV / AIDS
  • pregnancy
  • fluid electrolyte and acid-base disturbances
  • drugs: endocrine system

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Footnotes

  • Contributors ANA and MC contributed equally to this paper. They were responsible for discussing, planning and conduct the article. Both of the authors equally write the manuscript. TM: discuss and analysis of data. MJGMB: conception, analysis and interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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