title: Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms.
abstract: Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications. Shortly after surgery, he developed clear features of ADI with adipsic severe hypernatraemia and hypotonic polyuria, which was associated with cognitive impairment that was confirmed with biochemical investigations and cognitive assessments. He was treated with DDAVP along with a strict intake of oral fluids at scheduled times to maintain eunatremia. Repeat assessment at six months showed recovery of thirst and a normal water deprivation test. Management of ADI with cognitive impairment is complex and requires a multidisciplinary approach. Recovery from ADI is very rare, and this is only the second report of recovery in this particular clinical setting.
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland, Department of General Surgery, Waikato Hospital, Hamilton.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ndoro
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland.
authors.forename: Uchenna
authors.initials: U
authors.lastname: Okafo
authors.affiliation: Department of Endocrinology, Beaumont Hospital, Dublin, Republic of Ireland.
authors.forename: Aoife
authors.initials: A
authors.lastname: Garrahy
authors.affiliation: Department of Endocrinology, Beaumont Hospital, Dublin, Republic of Ireland.
authors.forename: Amar
authors.initials: A
authors.lastname: Agha
authors.affiliation: Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland.
authors.forename: Danny
authors.initials: D
authors.lastname: Rawluk
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003919:Diabetes Insipidus / Q000097:blood / Q000209:etiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D020127:Recovery of Function; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D001786:Blood Glucose