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


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.

Share and Cite:

Lara, D. , Joyanes, B. , Llaneza, A. , Pérez, O. , Llorente, B. and Runkle, I. (2013) Prolonged coexistent central diabetes insipidus and cerebral salt wasting syndrome following neurosurgery. Open Journal of Pediatrics, 3, 74-77. doi: 10.4236/ojped.2013.32014.

Conflicts of Interest

The authors declare no conflicts of interest.


[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.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.