PubMed · 2006 · 78 citations · 0 references
MedicineEndocrinologyNeurosurgeryDiabetologyNeuroendocrinologyRenal PathophysiologyDiabetes MellitusElectrolyte Disorder ManagementElectrolyte DisordersElectrolyte HomeostasisElectrolyte ManagementFluid Balance DisordersAdrenal Replacement TherapyDiabetes Insipidus SyndromesElectrolyte Disturbances ManagementElectrolyte Imbalance DisordersElectrolyte Transport DisordersFluid-electrolyte BalanceSalt Wasting DisordersVasopressin Secretion
Central diabetes insipidus occurs in 8–35 % of craniopharyngioma patients pre‑operatively and in 70–90 % post‑operatively, and postoperative fluid disorders follow a triphasic vasopressin pattern that can cause life‑threatening hyponatremia, necessitating close monitoring.
Pre-operative central diabetes insipidus has been reported in 8-35% of patients affected with craniopharyngioma, and in 70-90% after surgery. The management of postoperative polyuria and polydipsia can be challenging and fluid balance needs to be closely monitored. The classical triphasic pattern of endogenous vasopressin secretion--an initial phase of symptomatic diabetes insipidus occurring 24 hours after surgery; a second phase of inappropriate vasopressin secretion potentially causing hyponatraemia; and a third phase with a return to diabetes insipidus occurring up to 2 weeks later--is often complicated by cerebral salt wasting and thirst disorders. Inadequate adrenal replacement therapy and anticonvulsant agent treatment may increase the risk of life-threatening hyponatraemia in the course of desmopressin (DDAVP) treatment. Appropriate management, in order to avoid life-threatening or disabling electrolyte disturbances, requires a good grasp of the relevant pathophysiology. We review here the pathophysiology and management of the multiple fluid disorders encountered following surgery for craniopharyngiomas.