Options for individualizing therapy for postoperative central diabetes insipidus

Postoperative diabetes insipidus is a common life-threatening morbidity after pituitary surgery. More frequent neurosurgeon interventions make drugs adjustment very important for higher life quality in the case of postoperative complications. We present the case of personalized adjustment of drug dosage to treat postoperative diabetes insipidus in patient undergoing reccurent transnasal adenomectomy.

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Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

Neuroendocrinology ◽

10.1159/000503145 ◽

2019 ◽

Vol 110 (6) ◽

pp. 525-534 ◽

Cited By ~ 5

Author(s):

Alessandro Maria Berton ◽

Filippo Gatti ◽

Federica Penner ◽

Emanuele Varaldo ◽

Nunzia Prencipe ◽

...

Keyword(s):

Diabetes Insipidus ◽

Surrogate Marker ◽

Pituitary Surgery ◽

Central Diabetes Insipidus ◽

Optimal Timing ◽

Vasopressin Release ◽

Biochemical Alterations ◽

Post Surgery ◽

Patients At Risk ◽

Pituitary Lesion

Introduction: Central diabetes insipidus (CDI) is a frequent complication of pituitary surgery, but its diagnosis lacks standardized criteria. Copeptin, a surrogate marker of arginine vasopressin release, is triggered by psycho-physical stresses such as pituitary surgery. Low postoperative copeptin could predict CDI onset. The aims of this study were the validation of copeptin as a predictor of post-neurosurgical CDI and the identification of the optimal timing for its determination. Methods: Sixty-six consecutive patients operated for a hypothalamic-pituitary lesion were evaluated. Copeptin was determined preoperatively and at 1, 6, 12, 24 and 48 h post-extubation. Fifty-eight patients were reassessed after 3–6 months post-surgery to confirm transient (3 cases) or permanent CDI (5 cases) diagnosis. Results: A marked copeptin peak was identified at 1 h after extubation, when a value below or equal to 12.8 pmol/L had a good accuracy in identifying CDI cases (AUC 0.866, 95% CI 0.751–0.941). Moreover, a copeptin peak above 4.2 pmol/L excluded permanent forms (AUC 1, 95% CI 0.629–1). Regression analysis identified copeptin as the only significant predictor of CDI (OR 0.86, 95% CI 0.75–0.98, p = 0.02). A copeptin T1/T0 ratio below or equal to 1.47 identified patients at risk of isolated biochemical alterations even in the absence of an overt CDI. Conclusions: A prompt increase of copeptin is expected at 1 h after extubation. The absence of this peak is a reliable predictor of post-neurosurgical CDI.

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Predictors and Incidence of Central Diabetes Insipidus after Endoscopic Pituitary Surgery

Yearbook of Endocrinology ◽

10.1016/s0084-3741(08)79008-5 ◽

2008 ◽

Vol 2008 ◽

pp. 344-345

Author(s):

W. Ludlam

Keyword(s):

Diabetes Insipidus ◽

Pituitary Surgery ◽

Central Diabetes Insipidus

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Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus

Scientific Reports ◽

10.1038/s41598-021-95500-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoo Hyung Kim ◽

Yong Hwy Kim ◽

Young Soo Je ◽

Kyoung Ryul Lee ◽

Hwan Sub Lim ◽

...

Keyword(s):

Diabetes Insipidus ◽

Serum Sodium ◽

Transsphenoidal Surgery ◽

Pituitary Surgery ◽

Diagnostic Value ◽

Normal Serum ◽

Central Diabetes Insipidus ◽

Copeptin Level ◽

Percentage Difference ◽

Normal Serum Sodium

AbstractCopeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = − 42.2%) and also in the transient CDI group (P = 0.002, − 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.

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CENTRAL DIABETES INSIPIDUS AFTER ABDOMINAL SURGERY: A CASE REPORT

10.22541/au.163383671.14582948/v1 ◽

2021 ◽

Author(s):

Aarti Maharaj ◽

Kundan Jana ◽

Kalyana Janga ◽

Sheldon Greenberg ◽

Elie Fein

Keyword(s):

Case Report ◽

Blood Loss ◽

Abdominal Surgery ◽

Diabetes Insipidus ◽

Pituitary Surgery ◽

Central Diabetes Insipidus ◽

Intraoperative Blood Loss ◽

Prolonged Surgery

Post-operative polyuria due to Diabetes Insipidus is a commonly reported complication of pituitary surgery. However, central DI post abdominal surgery is rare and may be related to pre-existing DI or prolonged surgery with intraoperative blood loss. A thorough workup needs to be done to exclude central DI in such patients.

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Management of Diabetes Insipidus following Surgery for Pituitary and Suprasellar Tumors

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.4.2021.010 ◽

2021 ◽

Author(s):

Mussa Almalki ◽

Maswood M. Ahmad ◽

Imad Brema ◽

Mohammed Almehthel ◽

Khaled M. AlDahmani ◽

...

Keyword(s):

Diabetes Insipidus ◽

Pituitary Surgery ◽

Central Diabetes Insipidus ◽

Therapeutic Interventions ◽

Response To Treatment ◽

Csf Leak ◽

Close Monitoring ◽

Large Tumor ◽

Increased Risk ◽

Rathke's Cleft

Central diabetes insipidus (CDI) is a common complication of pituitary surgery. However, it is most frequently transient. It is defined by the excretion of an abnormally large volume of dilute urine with increasing serum osmolality. The reported incidence of CDI after pituitary surgery is variable; ranging from 0-90 %. Large tumor size, gross total resection, and intraoperative cerebrospinal fluid (CSF) leak usually have an increased risk of CDI as also seen with craniopharyngioma and Rathke’s cleft cysts. It can be associated with high morbidities and mortality if not promptly recognized and treated on time. It is essential to rule out other causes of postoperative polyuria to avoid unnecessary pharmacotherapy and iatrogenic hyponatremia. Once the diagnosis of CDI is established, close monitoring is required to evaluate the response to treatment and to determine whether the CDI is transient or permanent. This review outlines the evaluation and management of patients with CDI after pituitary and suprasellar tumors surgery to help recognize the diagnosis, consider the differential diagnosis, initiate therapeutic interventions, guide monitoring, and long-term management. Keywords: Central diabetes insipidus (CDI), polydipsia, polyuria, pituitary adenoma, preoperative risk factor, and pituitary surgery, arginine vasopressin, desmopressin, and treatment.

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