Prolonged coexistent central diabetes insipidus and cerebral salt wasting syndrome following neurosurgery

D. López de Lara, B. Joyanes, A. Llaneza, O. Pérez, B. Llorente, I. Runkle

Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain.
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.

DOI: 10.4236/ojped.2013.32014                

Abstract

The coexistence of different water homeostasis abnormalities following neurosurgery represents a diagnostic and therapeutic challenge for intensive care units. This paper reports the case of a 13 year-old boy who underwent surgery for a suprasellar tumour and, immediately after surgery, developed a cerebral abscess, persistent diabetes insipidus (DI) as well as cerebral salt wasting syndrome (CSWS). The early onset of CSWS following DI has been associated with a poor prognosis and increased mortality. In cases in which these abnormalities coexist, the increased polyuria secondary to the rise in natriuresis associated with CSWS might be erroneously interpreted as a sign of poor control of the DI, thereby leading to therapeutic mistakes. Treatment basically consists of restoring electrolytes and the joint administration of desmopressin and fludrocortisone.

Keywords

Electrolyte Disorder; Diabetes Insipidus; Cerebral Salt Wasting Syndrome; Neurosurgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Segura, S., Balaguer, M., Cambra, F.J., Zambudio, S., Martín, J.M. and Palomeque, A. (2007) Fluid and electrolyte disorders following surgery for brain tumors. Anales de Pediatría, 67, 225-230.
[2]	Srivatsa, A. and Majzoub, J. (2007) Disorders of water homeostasis. In: Fima, L., Ed., Pediatric Endocrinology, 5th Edition, Informa Healthcare, Boston, Massachusetts, 651-692.
[3]	Bergadá, I. (2009) Trastornos de la hipófisis posterior. In: Pombo, Ed., Tratado de Endocrinología Pediátrica, 4th Edition, McGraw-Hill Interamericana, Madrid, 336-344.
[4]	Murillo, M.A., Sanchez, E., Reina, A., Márquez, C. and Lopez, J. (2005) Tumores del sistema nervioso central: Manejo perioperatorio. Anales de Pediatría, 62, 500-501.
[5]	Hiranrat, P., Katavetin, P., Supornsilchai, V., Wacharasindhu, S. and Srivuthana, S. (2003). Water and sodium disorders in children undergoing surgical treatment of brain tumors. Journal of the Medical Association of Thailand, 86, 152-159.
[6]	Cardoso, A.P., Dragosavac, D., Araujo, S., Falcao, A.L., Terzi, R.G., Castro, M., Marcondes, F.G., Melo, T.G., Oliveira, R.A. and Cintra, E.A. (2007) Syndromes related to sodium and arginine vasopressin alterations in postoperative neurosurgery. Arquivos de Neuro-Psiquiatria, 65, 745-751. doi:10.1590/S0004-282X2007000500003
[7]	Santana, L., Hernández-Medina, E., Villanueva, A. And Sánchez-Palacios, M. (2006) Salt waste syndrome in subarachnoid hemorrhage. Nefrologia, 26, 513.
[8]	Palmer, B.F. (2009) Cerebral salt wasting. Uptodate review version 17.3.
[9]	Singh, S., Bohn, D., Carlotti, A.P., Cusimano, M., Rutka, J.T. and Halperin, M.L. (2002) Cerebral salt wasting: Truths, fallacies, theories, and challenges. Critical Care Medicine, 30, 2575-2579.
[10]	Ghirardello, S., Hopper, N., Albanese, A. and Maghnie, M. (2006). Diabetes Insipidus in craniopharyngioma: Postoperative management of water and electrolyte disorders. Journal of Pediatric Endocrinology & Metabolism, 1, 413-421.
[11]	Taplin, C.E., Cowel, C.T., Silink, M. and Ambler, G.R. (2006) Fludrocortisone therapy in cerebral salt wasting. Pediatrics, 118, e1904-e1908.
[12]	Decaux, G., Prospert, F., Namias, B. and Soupart, A. (1990). Utility of serum uric acid determination in the differential diagnosis between central diabetes insipidus and primary polidipsia. Journal of the American Society of Nephrology, 33, 174-178
[13]	Kurtoglu, S., Atabek, M.E., Keskin, M., Patiroglu, T., Kumandas, S. and Topaloglu, N. (2006). Rhabdimyosarcoma with coexistent diabetes insipidus and cerebral salt wasting as postoperative complication. Pediatrics International, 48, 79-81. doi:10.1111/j.1442-200X.2006.02161.x
[14]	Von Bismarck, P., Ankermann, T., Eggert, P., Claviez, A. and Fritsch, M.J. (2006) Diagnosis and management of cerebral salt wasting in children: the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). Child’s Nervous System, 22, 1275-1281. doi:10.1007/s00381-006-0091-x
[15]	Rabinstein, A.A. and Wijdicks, E.F. (2003) Hyponatremia in critically ill neurological patients. Neurologist, 9, 290-300. doi:10.1097/01.nrl.0000095258.07720.89
[16]	Lin, J.J., Lin, K.L., Hsia, S.H., Wu, C.T. and Wang, H.S. (2009) Combined central diabetes insipidus and cerebral salt wasting syndrome in children. Pediatric Neurology, 40, 84-87. doi:10.1016/j.pediat rneurol.2008.09.010
[17]	Jiménez, R., Casado-Flores, J., Nieto, M. and GarcíaTeresa, M.A. (2006) Cerebral salt wasting syndrome in children with acute central nervous syndrome injury. Pediatric Neurology, 35, 261-263. doi:10.1016/j.pediatrneurol.2006.05.004
[18]	Oruckaptan, H.H., Ozisik, P. and Akalan, N. (2000) Prolonged cerebral salt wasting syndrome associated with the intraventricular dissemination or brain tumors. Pediatric Neurology, 33, 16-20. doi:10.1159/000028969
[19]	Ohtonari, T., Hashimoto, M., Urasaki, E., Yokota, A., Araki, S., Asayama, K. and Shirahata, A. (2005) Prolonged cerebral salt wasting following craniopharyngioma surgery and posterior reversible encephalopathy syndrome: A case report. No To Shinkei, 57, 57-63.