CORRESPONDENCE
A Case of Nephrogenic Diabetes Insipidus During Transsphenoidal Pituitary Adenomectomy To JNA Readers: Central diabetes insipidus (DI) is a known complication of pituitary surgery and the symptoms are improved by replenishing antidiuretic hormone (ADH).1 We treated a patient with DI that developed during the perioperative period which was not responsive to ADH administration. A 66-year-old woman underwent transsphenoidal adenomectomy for an adrenocorticotrophic hormone-producing pituitary tumor. She had bipolar depression, and was treated with clonazepam, chlorpromazine, and lithium carbonate. Polyuria was noted on the hospitalization, which was diagnosed as psychogenic because of polyposia. The patient’s oral intake was >3000 mL/d with normal renal func-
tion, serum electrolytes, blood glucose, plasma osmotic pressure, and low urinary specific gravity. Before surgery, drinking was prohibited. Polyuria continued at 200 to 300 mL/h, whereas the specific gravity of urine remained unchanged. Hypernatremia and hypokalaemia were found after the beginning of surgery (Na 159, K 2.6 mmol/ L). Although we gave 12 U of vasopressin and changed bicarbonate Ringer solution to dextrose 5%, half normal saline with added potassium, hypernatremia, and hypokalaemia continued (Na 161, K 2.9 mmol/L). Polyuria remained even though intranasal desmopressin was properly administered, and then disorientation occurred postoperatively. On postoperative day 1, polyuria continued and hypernatremia deteriorated (Na 164, K 3.2 mmol/L). We suspected nephrogenic DI due to a side effect of lithium carbonate although the blood concentration of lithium was 0.35 mEq/ L (normal range,
A Case of Nephrogenic Diabetes Insipidus During Transsphenoidal Pituitary Adenomectomy To JNA Readers: Central diabetes insipidus (DI) is a known complication of pituitary surgery and the symptoms are improved by replenishing antidiuretic hormone (ADH).1 We treated a patient with DI that developed during the perioperative period which was not responsive to ADH administration. A 66-year-old woman underwent transsphenoidal adenomectomy for an adrenocorticotrophic hormone-producing pituitary tumor. She had bipolar depression, and was treated with clonazepam, chlorpromazine, and lithium carbonate. Polyuria was noted on the hospitalization, which was diagnosed as psychogenic because of polyposia. The patient’s oral intake was >3000 mL/d with normal renal func-
tion, serum electrolytes, blood glucose, plasma osmotic pressure, and low urinary specific gravity. Before surgery, drinking was prohibited. Polyuria continued at 200 to 300 mL/h, whereas the specific gravity of urine remained unchanged. Hypernatremia and hypokalaemia were found after the beginning of surgery (Na 159, K 2.6 mmol/ L). Although we gave 12 U of vasopressin and changed bicarbonate Ringer solution to dextrose 5%, half normal saline with added potassium, hypernatremia, and hypokalaemia continued (Na 161, K 2.9 mmol/L). Polyuria remained even though intranasal desmopressin was properly administered, and then disorientation occurred postoperatively. On postoperative day 1, polyuria continued and hypernatremia deteriorated (Na 164, K 3.2 mmol/L). We suspected nephrogenic DI due to a side effect of lithium carbonate although the blood concentration of lithium was 0.35 mEq/ L (normal range,
