Usefulness of anti-rabphilin-3A antibodies for diagnosing central diabetes insipidus in the third trimester of pregnancy

Kanako Sakurai, Rika Yamashita, Satsuki Niituma, Shintaro Iwama, Yoshihisa Sugimura, Zenei Arihara, Kazuhiro Takahashi

Research output: Contribution to journalComment/debate

1 Citation (Scopus)

Abstract

We report a 27-year-old pregnant woman with polyuria, polydipsia and headache in the third trimester of pregnancy. Hypernatremia (153 mEq/L), high plasma osmolality (300 mOsm/kgH2O) and low urinary osmolality (92 mOsm/kgH2O) were observed at the admission to our hospital. Plasma arginine vasopressin (AVP) level was inappropriately low (2.2 pg/mL) compared to the high plasma osmolality. Plasma AVP responses to hypertonic-saline infusion were blunted, and her urine osmolality increased in response to desmopressin. The diagnosis of central diabetes insipidus was made from these results. Magnetic resonance imaging (MRI) of hypothalamic-pituitary region demonstrated a significant enlargement of the pituitary stalk, suggesting the presence of hypophysitis. In addition, serum anti-rabphilin-3A antibodies that have been recently reported as a biomarker of lymphocytic infundibulo-neurohypophysitis, were positive. Diabetes insipidus continued after delivery, suggesting that polyuria was not mainly due to excessive vasopressinase activity or reduced renal sensitivity to AVP by prostaglandin E2 that can cause temporal polyuria during pregnancy. We therefore clinically diagnosed central diabetes insipidus due to lymphocytic infundibulo-neurohypophysitis, without performing invasive transsphenoidal pituitary biopsy. This case suggested the usefulness of anti-rabphilin-3A antibodies for the etiological diagnosis of central diabetes insipidus during pregnancy.

Original languageEnglish
Pages (from-to)645-650
Number of pages6
JournalEndocrine Journal
Volume64
Issue number6
DOIs
Publication statusPublished - 01-01-2017

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Neurogenic Diabetes Insipidus
Third Pregnancy Trimester
Polyuria
Osmolar Concentration
Arginine Vasopressin
Antibodies
Cystinyl Aminopeptidase
Hypernatremia
Polydipsia
Deamino Arginine Vasopressin
Pregnancy
Diabetes Insipidus
Pituitary Gland
Dinoprostone
Headache
Pregnant Women
Biomarkers
Magnetic Resonance Imaging
Urine
Kidney

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Sakurai, Kanako ; Yamashita, Rika ; Niituma, Satsuki ; Iwama, Shintaro ; Sugimura, Yoshihisa ; Arihara, Zenei ; Takahashi, Kazuhiro. / Usefulness of anti-rabphilin-3A antibodies for diagnosing central diabetes insipidus in the third trimester of pregnancy. In: Endocrine Journal. 2017 ; Vol. 64, No. 6. pp. 645-650.
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Usefulness of anti-rabphilin-3A antibodies for diagnosing central diabetes insipidus in the third trimester of pregnancy. / Sakurai, Kanako; Yamashita, Rika; Niituma, Satsuki; Iwama, Shintaro; Sugimura, Yoshihisa; Arihara, Zenei; Takahashi, Kazuhiro.

In: Endocrine Journal, Vol. 64, No. 6, 01.01.2017, p. 645-650.

Research output: Contribution to journalComment/debate

TY - JOUR

T1 - Usefulness of anti-rabphilin-3A antibodies for diagnosing central diabetes insipidus in the third trimester of pregnancy

AU - Sakurai, Kanako

AU - Yamashita, Rika

AU - Niituma, Satsuki

AU - Iwama, Shintaro

AU - Sugimura, Yoshihisa

AU - Arihara, Zenei

AU - Takahashi, Kazuhiro

PY - 2017/1/1

Y1 - 2017/1/1

N2 - We report a 27-year-old pregnant woman with polyuria, polydipsia and headache in the third trimester of pregnancy. Hypernatremia (153 mEq/L), high plasma osmolality (300 mOsm/kgH2O) and low urinary osmolality (92 mOsm/kgH2O) were observed at the admission to our hospital. Plasma arginine vasopressin (AVP) level was inappropriately low (2.2 pg/mL) compared to the high plasma osmolality. Plasma AVP responses to hypertonic-saline infusion were blunted, and her urine osmolality increased in response to desmopressin. The diagnosis of central diabetes insipidus was made from these results. Magnetic resonance imaging (MRI) of hypothalamic-pituitary region demonstrated a significant enlargement of the pituitary stalk, suggesting the presence of hypophysitis. In addition, serum anti-rabphilin-3A antibodies that have been recently reported as a biomarker of lymphocytic infundibulo-neurohypophysitis, were positive. Diabetes insipidus continued after delivery, suggesting that polyuria was not mainly due to excessive vasopressinase activity or reduced renal sensitivity to AVP by prostaglandin E2 that can cause temporal polyuria during pregnancy. We therefore clinically diagnosed central diabetes insipidus due to lymphocytic infundibulo-neurohypophysitis, without performing invasive transsphenoidal pituitary biopsy. This case suggested the usefulness of anti-rabphilin-3A antibodies for the etiological diagnosis of central diabetes insipidus during pregnancy.

AB - We report a 27-year-old pregnant woman with polyuria, polydipsia and headache in the third trimester of pregnancy. Hypernatremia (153 mEq/L), high plasma osmolality (300 mOsm/kgH2O) and low urinary osmolality (92 mOsm/kgH2O) were observed at the admission to our hospital. Plasma arginine vasopressin (AVP) level was inappropriately low (2.2 pg/mL) compared to the high plasma osmolality. Plasma AVP responses to hypertonic-saline infusion were blunted, and her urine osmolality increased in response to desmopressin. The diagnosis of central diabetes insipidus was made from these results. Magnetic resonance imaging (MRI) of hypothalamic-pituitary region demonstrated a significant enlargement of the pituitary stalk, suggesting the presence of hypophysitis. In addition, serum anti-rabphilin-3A antibodies that have been recently reported as a biomarker of lymphocytic infundibulo-neurohypophysitis, were positive. Diabetes insipidus continued after delivery, suggesting that polyuria was not mainly due to excessive vasopressinase activity or reduced renal sensitivity to AVP by prostaglandin E2 that can cause temporal polyuria during pregnancy. We therefore clinically diagnosed central diabetes insipidus due to lymphocytic infundibulo-neurohypophysitis, without performing invasive transsphenoidal pituitary biopsy. This case suggested the usefulness of anti-rabphilin-3A antibodies for the etiological diagnosis of central diabetes insipidus during pregnancy.

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DO - 10.1507/endocrj.EJ17-0028

M3 - Comment/debate

VL - 64

SP - 645

EP - 650

JO - Endocrine Journal

JF - Endocrine Journal

SN - 0918-8959

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