Differential Diagnosis for a 37-Year-Old Female in Her 4th Pregnancy
Single Most Likely Diagnosis
- Gestational Diabetes Mellitus (GDM): The patient's symptoms of nocturnal polyuria and polydipsia, along with the results of the 75g OGTT (FBS 112.97, 1hr 276, 2hr 221), strongly suggest GDM. The patient's father has a history of diabetes, which increases her risk.
Other Likely Diagnoses
- Chronic Hypertension: Given the patient's history of increased blood pressure during previous pregnancies (highest BP of 140 to 150 during the 3rd pregnancy), chronic hypertension should be considered, especially since she is being closely monitored for hypertension.
- Preeclampsia: Although the patient does not have a history of preeclampsia, her history of increased blood pressure during pregnancy puts her at risk. Close monitoring of blood pressure and proteinuria is necessary.
Do Not Miss Diagnoses
- Pregnancy-Induced Hypertension (PIH) with Severe Features: This condition can lead to significant maternal and fetal morbidity if not promptly recognized and managed. The patient's history of increased blood pressure during previous pregnancies increases her risk.
- Diabetic Nephropathy: Although the patient's serum creatinine is within normal limits (1.00), her family history of diabetes and current diagnosis of GDM warrant consideration of diabetic nephropathy, especially if she has had undiagnosed diabetes in the past.
Rare Diagnoses
- LADA (Latent Autoimmune Diabetes in Adults) or Type 2 Diabetes: Although less likely given the patient's age and lack of symptoms outside of pregnancy, these conditions should be considered, especially given the patient's family history of diabetes and her current diagnosis of GDM.
- Primary Aldosteronism: This rare condition can cause hypertension and should be considered if the patient's blood pressure is difficult to control, although it is less likely given the patient's presentation and lack of other symptoms.