Abstract
Introduction
Nephrogenic diabetes insipidus (DI) in the foetus has been described as a rare presentation of severe polyhydramnios.
Discussion
We report a case of foetal central DI, characterised by severe polyhydramnios. Significant polyuria was noted at birth. Serum AVP level was un-measurable (<0.5 pg/ml). A dramatic response to intravenous dDAVP (desmopressin) was noted confirming central DI. Further investigations did not reveal a recognised cause for central or nephrogenic DI. The infant thrived well on a small dose of oral desmopressin until the age of 12 months. At 13 months, a water deprivation test revealed a normal ability to concentrate urine without desmopressin, and subsequently, the infant has thrived without further treatment. The transient nature of the central DI remains obscure but could be explained by a maturational delay in the tissues involved in AVP synthesis or release, during intrauterine life and infancy.
Conclusion
Both nephrogenic and central DI should be considered as a cause of severe polyhydramnios. This may help to guide prompt intensive management and investigation, with attention to vascular access, central venous pressure, urine output monitoring and replacement.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barakat AJ, Pearl L, Acosta MT et al (2004) 22q13 deletion syndrome with diabetes insipidus: a previously unreported association. Clin Dysmorphol 13(3):191–194
Baylis PH, Cheetham T (1998) Diabetes insipidus. Arch Dis Child 79:84–89
Charmandari E, Brook CGD (1999) 20 years of experience in idiopathic central diabetes insipidus. Lancet 353:2212–2213
Cohen C, Rice EN, Thomas DE et al (1998) Diabetes insipidus as a hallmark neuroendocrine complication of neonatal meningitis. Curr Opin Pediatr 10(4):449–452
Colussi G (2005) Bartter syndrome. Orphanet encyclopedia; http://www.orpha.net/data/patho/GB/uk-Bartter.pdf. Accessed 6 Oct 2010
Jaruratanasirukul S, Janjindamai S, Sriplung H et al (2002) Etiologies of central diabetes insipidus in children: 15 years experience in Songklanagarind hospital, Thailand. J Med AssocThai 85(7):765–771
Kirshon B (1989) Fetal urine output in hydramnios. Obstet Gynecol 73:240–242
Lam A, Sibbald WJ, Boone J (1978) Transient diabetes insipidus as a complication of Haemophilus meningitis. Pediatrics 61:785–787
Lee YJ, Huang FY, Shen EY et al (1996) Neurogenic diabetes insipidus in children with hypoxic encephalopathy: six new cases and review of the literature. Eur J Pediatr 155(3):245–248
Maghnie M, Cosi G, Genovese E (2000) Central diabetes insipidus in children and young adults. N Engl J Med 343:998–1007
Mena W, Royal S, Pass RF et al (1993) Diabetes insipidus associated with symptomatic congenital cytomegalovirus infection. J Pediatr 122(6):911–913
Rabinowitz R, Peters MT, Vyas S et al (1984) Measurement fetal urine production rates in normal pregnancy by real time ultrasound. Am J Perinatol 161:1264–1266
Rizzo V, Albanese A, Stanhope R (2001) Morbidity and mortality associated with vasopressin replacement therapy in children. J Pediatr Endocrinol Metab 14:861–867
Robertson GL (2001) Diabetes Insipidus. In: Brook CGD, Hindmarsh PC (eds) Clinical pediatric endocrinology, 4th edn. Blackwell, London, pp 202–210
Sinha R, Martin P (2006) Post intra-ventricular hemorrhage neonatal cranial diabetes insipidus. Indian Pediatrics 43:267–269
Conflict of interests
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kollamparambil, T.G., Mohan, P.V., Gunasuntharam, K. et al. Prenatal presentation of transient central diabetes insipidus. Eur J Pediatr 170, 653–656 (2011). https://doi.org/10.1007/s00431-010-1340-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-010-1340-2