Endocrine Abstracts

JOINT2607

Introduction: Managing AVP deficiency in pregnancy can be challenging due to the physiological changes associated with pregnancy. These changes can impact both the mother and the unborn baby. Vasopressinase, an enzyme released by the placenta, acts as a degrader of vasopressin. In a healthy female, this enzyme has an insignificant effect. However, in women with incomplete AVP deficiency, the presence of vasopressinase can exacerbate the condition during pregnancy, leading to worsening polyuria and polydipsia. These women may require higher doses of Desmopressin to manage their symptoms effectively.

Case Presentation: A 35-year-old lady presented with headaches and hyperemesis gravidarum in the antenatal clinic and maternity triage unit. Her past medical history included a diagnosis of AVP deficiency following a previous miscarriage at 16 weeks. During subsequent pregnancy, she developed frank AVP deficiency. She had polyuria and polydipsia (drinking up to 20 litres per day). The neurology team assessed and reviewed her. She had an MRI pituitary with normal findings. She was treated for gestational diabetes with metformin and she was on desmopressin for her established AVP deficiency. Blood tests since January 2017 showed sodium level ranging between 133 – 144 mmol/lwith noticeably a decline in sodium level to 130 mmol/lin January 2024. Serum osmolality was found to be within the range of 275-295 mmol/kg and urine osmolality was intermediate (between 500-600 mmol/kg). The desmopressin dose was adjusted accordingly with close monitoring.

Conclusion: Pregnancy is associated with increased blood volume and glomerular distraction rate. The risk of Gestation AVP deficiency in patients with already established AVP deficiency cannot be ignored, and the dehydration is significant especially if the patient developed hyperemesis gravidarum. In summary, managing AVP deficiency in pregnancy can be challenging and warrants close monitoring of fluids and electrolytes. The treatment should be individualized, and an MDT approach is necessary to ensure the desired outcome.