title: Pituitary apoplexy precipitating diabetes insipidus after living donor liver transplantation.
abstract: Pituitary apoplexy occurring after surgery is a rare but life-threatening acute clinical condition that follows extensive hemorrhagenous necrosis within a pituitary adenoma. Pituitary apoplexy has been reported to occur spontaneously in the majority of cases or in association with various inducing factors. Reported is a case of pituitary apoplexy complicated by diabetes insipidus following living donor liver transplantation (LDLT). To the best of our knowledge, this has not been previously reported. A 56-year-old woman with nonalcoholic steatohepatitis underwent LDLT from her daughter. The patient also required dopamine support and transfusions because of massive intraoperative bleeding. Postoperatively, her coagulopathy continued, and she underwent a second laparotomy because of unknown bleeding on postoperative day 7, when she needed transfusions and dopamine support to maintain her vital signs. She complained of severe headache, excessive thirst, frequent urination, and diplopia from postoperative day 10. She also had polyuria greater than 300 ml/h and was diagnosed with pituitary apoplexy precipitating diabetes insipidus on postoperative day 13. She was treated conservatively without surgery because of the hormonally inactive status and slight mass effect of her tumor. It is important for anesthesiologists and critical care personnel in LDLT settings to take into consideration this complication as a differential diagnosis.
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan, matusakik@ybb.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsusaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morimatsu
authors.forename: Junya
authors.initials: J
authors.lastname: Matsumi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuda
authors.forename: Tetsufumi
authors.initials: T
authors.lastname: Sato
authors.forename: Kenji
authors.initials: K
authors.lastname: Sato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mizobuchi
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Morita
mesh_terms: D016063:Blood Loss, Surgical; D001921:Brain / Q000473:pathology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D020790:Diabetes Insipidus, Neurogenic / Q000209:etiology*; D003937:Diagnosis, Differential; D004298:Dopamine / Q000627:therapeutic use; D005234:Fatty Liver / Q000601:surgery; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000150:complications*; D010902:Pituitary Gland / Q000473:pathology; D011183:Postoperative Complications / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
chemical_list: D002316:Cardiotonic Agents; D004298:Dopamine