Coexistence of Central Diabetes Insipidus and Prolonged Cerebral Salt Wasting Syndrome after Brain Tumor Surgery: A Case Report

Abstract

Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after sur gery. Hyponatremia in a patient with CDI may be erroneously interpreted as ina de quate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.

Prolonged Postoperative Pyrexia and Transient Nonnephrogenic Vasopressin-Analogue-Resistant Polyuria following Endoscopic Transsphenoidal Resection of an Infundibular Epidermoid Cyst

“…The VARP interacts with central hyperthermia (PPP), which suggests an involvement of the abovementioned hypothalamic dysfunction during the transient VARP. This VARP may belong to the category of cerebral salt wasting syndrome coexisting with DI [ 29 ], or is VARP a new clinical entity? Further studies are warranted to answer this question.…”

“…If the eTSS resulted in insufficient resection, the Mollaret's meningitis would not have settled and been long lasting. Thus, surgical gross total resection remains the mainstay for treatment of intracranial epidermoid cysts [ 29 , 33 ]. Here, again, an infundibular epidermoid cyst should be sufficiently resected in one sitting, as much as possible within safe limits.…”