TY - JOUR T1 - Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-238410 VL - 14 IS - 3 SP - e238410 AU - Alexandra Novais Araújo AU - Maria Cunha AU - Tiago Marques AU - Maria João Guerreiro Martins Bugalho Y1 - 2021/03/01 UR - http://casereports.bmj.com/content/14/3/e238410.abstract N2 - 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. ER -