title: Unmasking of undiagnosed pre-existing central diabetes insipidus after renal transplantation.
abstract: Acquired central diabetes insipidus (CDI) often occurs abruptly after a cranial event causing hypothalamic or pituitary damage. We present a case of a patient with pre-existing and clinically unapparent CDI which was unmasked after renal transplantation. A 60 year old woman with end-stage renal failure due to autosomal dominant polycystic kidney disease (ADPKD) underwent renal transplantation. She was noted to be markedly polyuric and polydipsic after the transplant. A fluid deprivation test was unequivocally positive for CDI, and desmopressin treatment resulted in immediate symptom relief. Neuroimaging revealed a midline defect in the region of the hypothalamus. She had a history of an intracerebral aneurysm that had ruptured, requiring extensive neurosurgery many years previously. This case demonstrates a rare instance of pre-existing but clinically unapparent CDI unmasked by renal transplantation. It is likely that renal failure due to ADPKD disguised her CDI prior to transplantation. A previous intracerebral insult from an aneurysmal bleed is the likely cause of her vasopressin deficiency.
authors.affiliation: Department of Endocrinology, Auckland District Health Board, Level 1 Building 4, Greenlane Clinical Centre, Greenlane, Auckland, 1051, New Zealand. DKim@adhb.govt.nz
authors.forename: David D W
authors.initials: DD
authors.lastname: Kim
authors.forename: Ian M
authors.initials: IM
authors.lastname: Holdaway
mesh_terms: D003919:Diabetes Insipidus / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged
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