Acute-Onset CDI with Polyuria Persisting Beyond 48 Hours After Pituitary Surgery, Traumatic Brain Injury, or Subarachnoid Hemorrhage

This protocol addresses central diabetes insipidus that presents acutely following transsphenoidal or transcranial pituitary surgery, traumatic brain injury, or subarachnoid hemorrhage — specifically in patients whose polyuria has not resolved with the initial on-demand approach.

Clinical presentation

Acute onset of polyuria following transsphenoidal or transcranial pituitary surgery, traumatic brain injury, or subarachnoid hemorrhage, accompanied by hypernatremia and hypotonic urine.

Why this step is reached — prior therapy did not achieve its goals

Initial management with on-demand dDAVP aimed to resolve polyuria and maintain eunatremia. When those goals are not met and polyuria persists, a different treatment strategy is required. This protocol defines that next step.

Approach at this stage

When polyuria persists beyond 48 hours, a shift from as-needed to regularly scheduled parenteral administration becomes indicated. The complete regimen, dosing schedule, monitoring parameters, and eunatremia targets are in the full structured protocol.

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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 (see above), with no requirement to proceed to the WDT or measurement of AVP or copeptin.

As a triphasic response occasionally occurs, regular dDAVP is only indicated if polyuria persists beyond 48 hours.

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