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Diabetes insipidus as a complication after pituitary surgery

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 489–494 (2007)Cite this article

Abstract

Background A 28-year-old woman presented with new-onset vertigo and diplopia that had started 2 weeks previously. An MRI scan of the brain revealed an 11 × 9 ×9 mm sellar mass that extended into the suprasellar region. Evaluation of pituitary function showed mild central hypothyroidism and secondary adrenal insufficiency. The patient underwent trans-sphenoidal resection of the mass without any significant intraoperative complications. On postoperative day 1 she abruptly developed polyuria, hypernatremia and urine hypo-osmolality.

Investigations Measurements of plasma and urine osmolality, urine specific gravity, and serum sodium levels.

Diagnosis Postoperative diabetes insipidus with a triphasic pattern.

Management The patient's diabetes insipidus was initially treated with intravenous desmopressin, and her fluid status, serum sodium levels, and serum and urine osmolality were carefully monitored. During the second, antidiuretic phase, desmopressin was discontinued and the patient's fluid intake was restricted. After recurrence of diabetes insipidus during the third phase, the patient was treated with intranasal desmopressin and was discharged. She remains on desmopressin therapy for chronic diabetes insipidus.

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Figure 1: Preoperative and postoperative MRI scans of the patient's pituitary gland
Figure 2: Postoperative pattern of triphasic diabetes insipidus
Figure 3: Mechanisms that underlie the pathophysiology of the triphasic pattern of postoperative diabetes insipidus

References

  1. Hensen J et al. (1999) Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf) 50: 431–439

    Article  CAS  Google Scholar 

  2. Nemergut EC et al. (2005) Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg 103: 448–454

    Article  Google Scholar 

  3. Hollinshead WH (1964) The interphase of diabetes insipidus. Mayo Clin Proc 39: 92–100

    CAS  PubMed  Google Scholar 

  4. Verbalis JG et al. (1984) Postoperative and post-traumatic diabetes insipidus. In Diabetes Insipidus in Man, 247–265 (Eds Czernichow P and Robinson AG,), Basel: S Karger

    Google Scholar 

  5. Ultmann MC et al. (1992) Transient hyponatremia after damage to the neurohypophyseal tracts. Neuroendocrinol 56: 803–811

    Article  CAS  Google Scholar 

  6. Olson BR et al. (1995) Isolated hyponatremia after transsphenoidal pituitary surgery. J Clin Endocrinol Metab 80: 85–91

    CAS  PubMed  Google Scholar 

  7. Lipsett MB et al. (1956) An analysis of the polyuria induced by hypophysectomy in man. J Clin Endocrinol Metab 16: 183–195

    Article  CAS  Google Scholar 

  8. Robinson AG and Verbalis JG (2003) The posterior pituitary. In Williams Textbook of Endocrinology, 281–329 (Eds Larsen PR et al.) Philadelphia: WB Saunders

    Google Scholar 

  9. Robertson GL (1995) Diabetes insipidus. Endocrinol Metab Clin North Am 24: 549–572

    Article  CAS  Google Scholar 

  10. Tien R et al. (1991) MR imaging of the brain in patients with diabetes insipidus. Am J Neuroradiol 12: 533–542

    CAS  PubMed  Google Scholar 

  11. Maghnie M et al. (1997) Persistent high MR signal of the posterior pituitary gland in central diabetes insipidus. AJNR Am J Neuroradiol 18: 1749–1752

    CAS  PubMed  Google Scholar 

  12. Richardson DW and Robinson AG (1985) Desmopressin. Ann Intern Med 103: 228–239

    Article  CAS  Google Scholar 

  13. Verbalis JG (2003) Diabetes insipidus. Rev Endocr Metab Disord 4: 177–185

    Article  Google Scholar 

  14. Bohn D et al. (2005) Acute and fatal hyponatraemia after resection of a craniopharyngioma: a preventable tragedy. QJM 98: 691–703

    Article  CAS  Google Scholar 

  15. Lugo N et al. (1997) Diagnosis and management algorithm of acute onset of central diabetes insipidus in critically ill children. J Pediatr Endocrinol Metab 10: 633–639

    Article  CAS  Google Scholar 

  16. Robertson GL (1983) Thirst and vasopressin function in normal and disordered states of water balance. J Lab Clin Med 101: 351–371

    CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. JA Loh is a fellow in the Georgetown University–Washington Hospital Center Endocrinology and Metabolism Training Program. JG Verbalis is a Professor and interim Chair of the Department of Medicine, Georgetown University, Washington, DC, USA.,

    Jennifer A Loh & Joseph G Verbalis

Authors
  1. Jennifer A Loh
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  2. Joseph G Verbalis
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Correspondence to Joseph G Verbalis.

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The authors declare no competing financial interests.

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Loh, J., Verbalis, J. Diabetes insipidus as a complication after pituitary surgery. Nat Rev Endocrinol 3, 489–494 (2007). https://doi.org/10.1038/ncpendmet0513

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