Skip to main content Skip to main navigation menu Skip to site footer

Diabetes insipidus after suprasellar tumor surgery: case report

  • Yuriz Bakhtiar ,
  • Muhamad Thohar Arifin ,
  • Adrian Pratama ,
  • Jacob Bunyamin ,

Abstract

Introduction: Diabetes insipidus (DI) is a rare water and electrolyte imbalance with hypovolemic hypernatremia characteristic (1:25.000) however can be potentially fatal if not well-anticipated and managed adequately. Brain tumors, either operated or not, may lead to DI (25%). Based on anatomical location, the suprasellar tumor may cause hypophyseal hormone dysfunction. Sellar region tumors can be classified into hypophyseal (90%) and non-hypophyseal (10%). Non-hypophyseal tumors with neurological deficits are more often causing hypophyseal hormone hyposecretion including DI. Sellar tubercle meningioma is one of the sellar region non-hypophyseal tumors which is often encountered and surgically managed. Worsening symptoms may become the surgical indication e.g. headache and visual disturbance. 

Case: We are reporting two meningioma cases in Salatiga local hospital with almost similar tumor characteristics either size and frontal lobe location. Both cases were managed by similar transcranial tumor excision craniotomy. Their differences were in the presence of neurological manifestations and the degree of hypothalamic compression. One patient developed postoperative DI without thirst thus the clinical manifestation was polyuria which was closely monitored in the intensive ward. We were convinced that the DI incidence was affected by the tumor manifestation and location which can be assessed by computed tomography (CT) scans.

Conclusion: The clinicians should anticipate the possibility of post craniotomy DI thus may provide adequate monitoring and management in patients developing postoperative DI.

References

  1. Winn RH. Youmans & Winn Neurological Surgery. 7th edition. Philadelphia: Elsevier; 2017
  2. Greenberg MS. Handbook of Neurosurgery. 8th edition. New York: Thieme; 2016
  3. He J, Jia G, Jia W, Li D, Ni M, Wang S, et al. Clinical Predictors of Diabetes Insipidus After Transcranial Surgery for Pituitary Adenoma. World Neurosurg. 2017; 101:1-10
  4. Aimaretti G, Corneli G, Croce CG, Ghigo E, Grottoli S, Rovere S, et al. Endocrine dysfunction in patients operated on for non-pituitary intracranial tumors. European Journal of Endocrinology. 2006; 155:559-566
  5. Das K, Joseph F, Khan M, Mon A, Sharma D, Sinha A, et al. Cranial diabetes insipidus with pituitary stalk lesion. QJM: An International Journal of Medicine. 2016; 109:703-8
  6. Bronstein MD, Glezer A, Paraiba DB. Rare Sellar Lesions. Endocrinol Metab Clin N Am. 2008; 37:195-211
  7. Dotan S, Mizrahi CJ, Mosovici S, Spektor S. Optic Nerve Vascular Compresion in a Patient with a Tubercullum Sellae Meningioma. Case Reports in Ophthalmological Medicine 2015
  8. Chai Y, Kondo A, Oshitari T, Yamamoto S, Yamazaki H. Case of acute optic nerve compression caused by tubercullum sellae meningioma with optic canal involvement. Clinical Ophthalmology. 2012; 6:661-6
  9. Mikoś H, Moszyńska MO, Niedziela M, Perek D. Diabetes insipidus coexisting with sellar-suprasellar tumor- case report. Wspolczesna Onkol. 2011;15(6):397-400
  10. Chowdhury S, Kalra S, Jain SM, Malve H, Thakkar PB, Thomas N, et al. Diabetes insipidus: The other diabetes. Indian J Endocr Metab. 2016;20:9-21
  11. Lamas C, Pozo C, Villabona C. Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery. Endocrinol Nutr. 2014;61:15-24
  12. Barger GR, Modawi I, Rossi NF. Central diabetes insipidus and adipsia due to astrocytoma: diagnosis and management. CEN Case Rep. 2013;2:11-6
  13. Lee DH, Saleem SN, Said AHM. Lesions of the Hypothalamus: MR Imaging Diagnostic Features. RadioGraphics. 2007;27:1087-1108
  14. Hoorn EJ, Zietse R. Water balance disorders after neurosurgery: the triphasic response revisited. NDT Plus. 2010;3:42-4
  15. Boot AM, Claahsen-van der Grinten HL, Finken MJJ, Han K, Hoving EW, Kruis RWJ, et al. Management and consequences of postoperative fluctuations in plasma sodium concentration after pediatric brain tumor surgery in the sellar regions: a national cohort analysis. Pituitary 2018;21:384-392
  16. Baysefer A, Erdogan E, Gezen F, Timurkaynak E, Seber N. Surgical Treatment of Sellar Regions Neoplasms. Turkish Neurosurgery. 1997;7:1-4
  17. Hamada S, Nabih A, Nosseir M, Osman M, Saoud K, Wild A. Evaluation of Tumor Resection and Optic Aparatus Decompression in Cases of Supra-sellar and Parasellar Meningioma Using Two Different Surgical Modalities: A Comparative Studies. EC Neurology. 2019;11:949-957
  18. Cheng XB, Lu ZF, Shi BZ, Zhao YG. Twenty-nine cases of resection of suprasellar meningioma through small bone window: an interhemispheric approach. Contemp Oncol. 2013;17(6):525-9

How to Cite

Bakhtiar, Y., Arifin, M. T., Pratama, A., & Bunyamin, J. (2020). Diabetes insipidus after suprasellar tumor surgery: case report. Intisari Sains Medis, 11(2), 722–727. https://doi.org/10.15562/ism.v11i2.807

HTML
373

Total
257

Share

Search Panel