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Diabetes insipidus in pregnancy
464
Selected
abstracts
ment. In 6 instances of recurrent abortion each taking place between the sixth and tenth week of pregnancy, 15 mg. allylestrenol was given daily from the sixteenth to the twenty-sixth day of the cycle for 3 months. One conceived in the first cycle, 3 in the second, and 1 in the third. The remaining patient showed full secretory endometrium but failed to conceive. The 5 who conceived were given a further course of 10 mg. daily for 16 weeks. Three pregnancies continued to term, one continued to term despite several small hemorrhages during the early weeks and one pregnancy was ended by an abortion at the twelfth week. One instance of threatened abortion in a patient who previously had had a normal pregnancy was treated with 15 mg. allylestrenol daily from the tenth week for 10 days. Bleeding continued and curettage was required eventually. Seven patients with suspected failure of nidation in whom the endometrium had shown poor secretory activity and whose temperature charts had low biphasic readings were given 15 mg. of allylestrenol daily from the sixteenth to the twenty-sixth day of each cycle for 2 months. Biopsy specimens in the immediate premenstrual phase showed secretory activity. Five patients became pregnant within 3 or 4 months aborted
after biopsy at the eighth
although one week. Despite
of these treatment
for
8 months, 2 patients did not conceive. Two patients, each of whom had had one previous child but who had secondary amenorrhea, were each given 10 mg. allylestrenol daily for 20 days in successive cycles without estrogen Neither patient had any menstrual priming. loss. Six patients with menorrhagia thought to be due only to hormonal imbalance had been treated with hormones or by currettage during the previous 18 months with temporary or little relief. Three had received testosterone with valuable results in 2 although testosterone was discontinued in all because of side effects. Five of these patients were each given 15 mg. allylestrenol daily from the twelfth to the twentysixth day. In 3 the results were satisfactory in that the period of bleeding was reduced and the loss, although it remained heavy, became less with each successive cycle. Two patients failed to respond. The sixth patient received 15 mg. of allylestrenol from the fifth to the twenty-fifth day but she had such severe hemorrhage that hysterectomy was performed after one cycle.
Four patients hacl metropathia, all of whom had had a curettage without any abnormal pclvie pathological changes being found and in whom endometrial biopsies showed the typical pattern of irregular epithelial shedding. After receiving 15 mg. allylestrenol daily from the twelfth to the twenty-sixth day of the cycle fot 3 cycles, 3 of these patients were found to have secretory endometria. Two patients improved but their endometria were described as poor secretory in character. One patient became pregnant. Six other patients whose menstrual loses were clearly anovular were given estrogens followed by allylestrenol. In all, secretory endometrium and satisfactory luteal phases were produced. Two patients with endometriosis were treated but the results were unsatisfactory. Four patients with primary dysmenorrhea were treated with 10 mg. of allylestrenol daily for about 3 weeks of the cycle In 2 of these patients the response was excellent. In the other 2 there was slight improvement but the drug had to be discontinued because of increased libido. Allylestrenol, therefore, although not the most potent of the synthetic orally active progestogens was very well tolerated and gave results expected of a progestogen. The increased libido induced in 2 patients with dysmenorrhea was unexpected inasmuch as pharmacological examination Further
found the investigation
drug to be is required.
not
androgenic.
David
Wiener
klinische
Kydd
Wochenschrift
Vol. 71, May 8, 1959. “Szendi, B., and Lakatos, I.: Diabetes in Pregnancy, p. 338.
Szendi
M.
and Lakatos: Diabetes Pregnancy, p. 338.
Insipidus
Insipidus
in
Clinical data are presented from a 2 l-year-old primigravid dwarf with the combination of diabetes insipidus and pregnancy. Vaginal delivery of a 2,700 gram infant was possible. Details of the management of the patient are given, and an extensive analysis of the pertinent literature is presented. The authors conclude that diabetes insipidus is an isolated disturbance of the diencephalichypophyseal system and that the remaining hormonal functions of this system, including its oxytocic function, are not altered by diabetes insipidus. Douglas M. Haynes
Selected
abstracts
ment. In 6 instances of recurrent abortion each taking place between the sixth and tenth week of pregnancy, 15 mg. allylestrenol was given daily from the sixteenth to the twenty-sixth day of the cycle for 3 months. One conceived in the first cycle, 3 in the second, and 1 in the third. The remaining patient showed full secretory endometrium but failed to conceive. The 5 who conceived were given a further course of 10 mg. daily for 16 weeks. Three pregnancies continued to term, one continued to term despite several small hemorrhages during the early weeks and one pregnancy was ended by an abortion at the twelfth week. One instance of threatened abortion in a patient who previously had had a normal pregnancy was treated with 15 mg. allylestrenol daily from the tenth week for 10 days. Bleeding continued and curettage was required eventually. Seven patients with suspected failure of nidation in whom the endometrium had shown poor secretory activity and whose temperature charts had low biphasic readings were given 15 mg. of allylestrenol daily from the sixteenth to the twenty-sixth day of each cycle for 2 months. Biopsy specimens in the immediate premenstrual phase showed secretory activity. Five patients became pregnant within 3 or 4 months aborted
after biopsy at the eighth
although one week. Despite
of these treatment
for
8 months, 2 patients did not conceive. Two patients, each of whom had had one previous child but who had secondary amenorrhea, were each given 10 mg. allylestrenol daily for 20 days in successive cycles without estrogen Neither patient had any menstrual priming. loss. Six patients with menorrhagia thought to be due only to hormonal imbalance had been treated with hormones or by currettage during the previous 18 months with temporary or little relief. Three had received testosterone with valuable results in 2 although testosterone was discontinued in all because of side effects. Five of these patients were each given 15 mg. allylestrenol daily from the twelfth to the twentysixth day. In 3 the results were satisfactory in that the period of bleeding was reduced and the loss, although it remained heavy, became less with each successive cycle. Two patients failed to respond. The sixth patient received 15 mg. of allylestrenol from the fifth to the twenty-fifth day but she had such severe hemorrhage that hysterectomy was performed after one cycle.
Four patients hacl metropathia, all of whom had had a curettage without any abnormal pclvie pathological changes being found and in whom endometrial biopsies showed the typical pattern of irregular epithelial shedding. After receiving 15 mg. allylestrenol daily from the twelfth to the twenty-sixth day of the cycle fot 3 cycles, 3 of these patients were found to have secretory endometria. Two patients improved but their endometria were described as poor secretory in character. One patient became pregnant. Six other patients whose menstrual loses were clearly anovular were given estrogens followed by allylestrenol. In all, secretory endometrium and satisfactory luteal phases were produced. Two patients with endometriosis were treated but the results were unsatisfactory. Four patients with primary dysmenorrhea were treated with 10 mg. of allylestrenol daily for about 3 weeks of the cycle In 2 of these patients the response was excellent. In the other 2 there was slight improvement but the drug had to be discontinued because of increased libido. Allylestrenol, therefore, although not the most potent of the synthetic orally active progestogens was very well tolerated and gave results expected of a progestogen. The increased libido induced in 2 patients with dysmenorrhea was unexpected inasmuch as pharmacological examination Further
found the investigation
drug to be is required.
not
androgenic.
David
Wiener
klinische
Kydd
Wochenschrift
Vol. 71, May 8, 1959. “Szendi, B., and Lakatos, I.: Diabetes in Pregnancy, p. 338.
Szendi
M.
and Lakatos: Diabetes Pregnancy, p. 338.
Insipidus
Insipidus
in
Clinical data are presented from a 2 l-year-old primigravid dwarf with the combination of diabetes insipidus and pregnancy. Vaginal delivery of a 2,700 gram infant was possible. Details of the management of the patient are given, and an extensive analysis of the pertinent literature is presented. The authors conclude that diabetes insipidus is an isolated disturbance of the diencephalichypophyseal system and that the remaining hormonal functions of this system, including its oxytocic function, are not altered by diabetes insipidus. Douglas M. Haynes