Disclosures: Armando Alvarez, MD, MPH: No financial relationships or conflicts of interest

Case Description: The patient was diagnosed with a large suprasellar craniopharyngioma after developing ataxia and headache. She underwent resection of the mass. Post-operatively, she developed central diabetes insipidus (CDI) and was started on Desmopressin Acetate Nasal Spray (DDAVP). On admission to IRF, she demonstrated impaired cognition, dysphagia, and urinary incontinence. Basic metabolic panels (BMP) were obtained. Serum sodium levels fluctuated greatly from 132 mmol/L to 161 mmol/L, prompting frequent adjustment of her DDAVP regimen by endocrinology. She experienced headaches and increased confusion when hypernatremic.

Setting: Inpatient Rehabilitation Facility (IRF)

Patient: 57-year-old woman with suprasellar mass Assessment/

Results: Among the difficulties encountered in managing her CDI was measuring her urine output without the use of an indwelling catheter due to incontinence. Her fluid intake was also very variable in the setting of an absent thirst drive and dysphagia requiring a modified consistency diet. The rehabilitation team was directed to ensure she drank at least 1.5 liters daily. Urine specific gravity levels were checked frequently, and she received an additional dose of DDAVP when levels revealed inappropriately dilute urine.

Discussion: CDI can be induced by neurosurgery or trauma to the hypothalamus and posterior pituitary. It is more common following resection of large tumors, with a reported incidence as high as 60 to 80 percent after such surgeries. Some affected patients may also have an impaired thirst drive likely due to damage to the hypothalamus. Monitoring of urine specific gravity can help guide treatment, particularly in cases in which monitoring urinary output may be difficult due to incontinence.

Conclusion: Patients are at risk for developing CDI following resection of suprasellar tumors. Strict ins and outs are vital to the health and function of these patients, though monitoring of the urine specific gravity can be a helpful adjunct when the patient’s impairments make this difficult.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/challenges-in-managing-the-other-diabetes-insipidus-on-the-rehabilitation-unit-a-case-report/