Acute fatty liver during pregnancy and gestational diabetes insipidus: a case report

lap. Imaging findings, such as on abdominal ultrasound, computed tomography, and magnetic resonance imaging, may support the diagnosis, but such images are not required for the diagnosis [2]. A liver ultrasound may show non-specific changes, including fatty infiltration or brightness. Although a liver biopsy can make a definite diagnosis of AFLP, it is too invasive to be routinely performed [2, 5]. Early diagnosis and treatment decreased the risk of life-threatening consequences for the mother and fetus. Prompt delivery is thought to effectively improve prognosis [1, 5]. Another complication of pregnancy is GDI, which is characterized by polydipsia and hypotonic polyuria. GDI has an incidence of approximately four cases for every 100,000 pregnancies [6]. It is thought to be caused by decreased AVP levels secondary to excessive vasopressinase activity [7]. Vasopressinase is a placental enzyme that degrades both AVP and oxytocin [6] but not deamino-Cys 1,D-arg 8-vasopressin (dDAVP) [8], which is a synthetic form of endogenous AVP with a different N-terminal. Although AVP levels increase during pregnancy to maintain sufficient antidiuretic activity, vasopressinase levels from the placenta may increase as well, thereby resulting in a decreased renal effect; this increase is the main cause of subclinical diabetes insipidus [6]. However, in pregnant women with impaired liver function (such as AFLP, Acute fatty liver during pregnancy and gestational diabetes insipidus: a case report