Clinical Scenario

Acute onset of polyuria following transsphenoidal or transcranial pituitary surgery, traumatic brain injury, or subarachnoid hemorrhage, with hypernatremia and hypotonic urine. Onset typically occurs within 1–2 days of neurosurgery, or with a median of 6 days following traumatic brain injury or subarachnoid hemorrhage. In this setting, the diagnosis is established on the basis of hypernatremia with hypotonic urine — no water deprivation test is required.

Treatment Approach (Overview)

Management centres on an antidiuretic agent to limit renal water losses, used on an on-demand rather than fixed-schedule basis. Fluid management — either by allowing the patient to drink to thirst or, when clinically necessary, via supplemental intravenous fluids — is an integral part of the approach. The complete protocol, including agent selection, dosing, sequencing, and fluid strategy, is available via the full structured regimen.

References

DOI: 10.1210/clinem/dgac381

Acute onset of CDI is observed most frequently following transsphenoidal or transcranial surgery for pituitary tumor, TBI, and subarachnoid hemorrhage.
The characteristic presentation is with sudden onset of polyuria, within 1 to 2 days following neurosurgery and later, with a median of 6 days after traumatic insult.
CDI is diagnosed on the basis of hypernatremia associated with hypotonic urine, with no requirement to proceed to the WDT or measurement of AVP or copeptin.
Treatment is based on limiting renal water losses with dDAVP; subsequent doses given as a single dose is occasionally sufficient with transient CDI.
The patient should be allowed to drink water to thirst; if the patient is cognitively impaired, supplemental appropriate intravenous fluids can maintain eunatremia.
Acute CDI is usually transient and may recede after a single dose of parenteral dDAVP.
Further parenteral doses are only required if polyuria persists; a recent survey of pituitary endocrinologists found a strong consensus for the use of "on-demand" postoperative dDAVP rather than regular dosage.

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Treatment of Central Diabetes Insipidus After Pituitary Surgery, Traumatic Brain Injury, or Subarachnoid Hemorrhage

References