Diabetes insipidus in craniopharyngioma: postoperative management of water and electrolyte disorders.
Pre-operative central diabetes insipidus has been reported in 8-35% of patients affected with craniopharyngioma, and in 70-90% after surgery. The management of postoperative polyuria and polydipsia can be challenging and fluid balance needs to be closely monitored. The classical triphasic pattern of endogenous vasopressin secretion--an initial phase of symptomatic diabetes insipidus occurring 24 hours after surgery; a second phase of inappropriate vasopressin secretion potentially causing hyponatraemia; and a third phase with a return to diabetes insipidus occurring up to 2 weeks later--is often complicated by cerebral salt wasting and thirst disorders. Inadequate adrenal replacement therapy and anticonvulsant agent treatment may increase the risk of life-threatening hyponatraemia in the course of desmopressin (DDAVP) treatment. Appropriate management, in order to avoid life-threatening or disabling electrolyte disturbances, requires a good grasp of the relevant pathophysiology. We review here the pathophysiology and management of the multiple fluid disorders encountered following surgery for craniopharyngiomas.
Ghirardello
Stefano
S
Department of Pediatrics, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Hopper
Neil
N
Albanese
Assunta
A
Maghnie
Mohamad
M
D002648:Child; D003397:Craniopharyngioma / Q000150:complications* / Q000601:surgery; D003919:Diabetes Insipidus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007010:Hyponatremia / Q000209:etiology / Q000628:therapy; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D013894:Thirst; D014667:Vasopressins / Q000037:antagonists & inhibitors; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*
D014667:Vasopressins