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Postoperative diabetes insipidus associated with pituitary apoplexy during pregnancy.
MedLine Citation:
PMID:  22592189     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI). Case Presentation: A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation. Conclusion: Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion.
Authors:
Daisuke Kita; Yasuhiko Hayashi; Hiroki Sano; Toshinari Takamura; Yutaka Hayashi; Osamu Tachibana; Jun-Ichiro Hamada
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-17
Journal Detail:
Title:  Neuro endocrinology letters     Volume:  33     ISSN:  0172-780X     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-5-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8008373     Medline TA:  Neuro Endocrinol Lett     Country:  -    
Other Details:
Languages:  ENG     Pagination:  107-112     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, Kanazawa University Hospital, Kanazawa, Japan. yahayashi@ns.m.kanazawa-u.ac.jp; kitad@ns.m.kanazawa-u.ac.jp.
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