Adipsic Diabetes Insipidus After Second Resection of A Hypothamic Astrocytoma

Abstract

Objective We are reporting a case of adipsic diabetes insipidus (ADI) post astrocytoma resection. Method Clinical and laboratory data are presented Results 16-year-old female with a history of incompletely resected hypothalamic astrocytoma admitted with headache. Head MRI showed interval increase in suprasellar lesion with extension to the third ventricle. Following second stage resection, she developed increased urine output with diluted urine resulting in negative fluid balance, however, she was unable to sense thirst. Blood tests showed serum sodium of 155 mEq/dl (136–145), serum osmolality at 321 mOs/kg ( 285–295 ) and urine osmolality of 128 mOsm/kg (300–1600 ). Serum creatinine and potassium were normal. Pituitary hormone profile were normal : Growth Hormone 0.171 ng/ml (0.123–8.05), LH 3.44 miu/ml (7.59–89.08), FSH 5.60 miu/ml (2.55–16.69) TSH 2.9 miu/ml (0.35–4.94), Free Thyroxine 0.92 ng/dl (0.7–1.48), ACTH 19.56 pg/ml (7.2–63.3) and Prolactin 7.25 ng/ml (5.18–26.53). The patient was treated with Desmopressin Acetate 120 mcg tablets twice daily with a fixed fluid intake of 1.5 to 2.0 liters/day with closed monitoring of fluid intake, output and body weight. Response was good with gradual reduction of serum sodium level of around 7–9 mEq/L/Day. Conclusions Adipsic diabetes insipidus is a rare entity of central diabetes insipidus, where the absence of polydipsia can be challenging in diagnosing and managing the condition. Cases of ADI are likely under reported and clinicians need to be aware of this condition

When Thirst Ceases to Exist: A Case Report and Literature Review of Adipsic Diabetes Insipidus Following Coil Embolization of a Ruptured Anterior Communicating Artery Aneurysm

“…The risk of developing the condition following repair of an anterior communicating artery aneurysm is around 0.04% (with meta-analyses noting coiling associated with better outcomes over clipping) [ 16 ]. Following aneurysmal ruptures, the next most common causes include craniopharyngiomas (13-30%) and congenital causes (5-20%) [ 62 ]. As demonstrated in the study by Mavrakis and Tritos [ 6 ], patients with adipsic diabetes insipidus and a ruptured anterior communicating artery aneurysm are significantly likely to be older than those with craniopharyngiomas, germinomas, or congenital condition (age 39.8 +/- 3.2 versus 23.1 +/- 4.9 versus 13.3 +/- 1.0 versus 5.5 +/- 2.4 years, p < 0.001).…”

“…With injury to the hypothalamic thirst centers, adipsia may remain alongside the central diabetes insipidus. Adipsic disorders are classified into four subtypes, A through D, with the patient described in the case report presenting with Type C Adipsia (Table 4 ) [ 62 , 112 , 113 ].…”

“…Yang et al [ 33 ] note that patients with adipsic diabetes insipidus are likely to have longer hospital durations compared to controls (9.6 days compared to 5.9 days, p = 0.000). Of note, however, as noted by Elamin et al [ 62 ], such patients are often paradoxically at risk of hyponatremia due to the inability to appreciate fluid overload when adherent to oral hydration and desmopressin administration.…”

“…Patients are furthermore prescribed desmopressin (DDAVP) to achieve a urine output of 1.5-2 liters daily. The dosage of desmopressin varies, as well as formulation (oral: 100- 250 micrograms twice daily; intranasal 3-10 micrograms twice per day) [ 62 , 63 ]. Oral absorption is often less preferable due to the significant variation with individuals and must be taken on an empty stomach [ 110 ].…”