Unmasking of undiagnosed pre-existing central diabetes insipidus after renal transplantation.

Abstract

Acquired central diabetes insipidus (CDI) often occurs abruptly after a cranial event causing hypothalamic or pituitary damage. We present a case of a patient with pre-existing and clinically unapparent CDI which was unmasked after renal transplantation. A 60 year old woman with end-stage renal failure due to autosomal dominant polycystic kidney disease (ADPKD) underwent renal transplantation. She was noted to be markedly polyuric and polydipsic after the transplant. A fluid deprivation test was unequivocally positive for CDI, and desmopressin treatment resulted in immediate symptom relief. Neuroimaging revealed a midline defect in the region of the hypothalamus. She had a history of an intracerebral aneurysm that had ruptured, requiring extensive neurosurgery many years previously. This case demonstrates a rare instance of pre-existing but clinically unapparent CDI unmasked by renal transplantation. It is likely that renal failure due to ADPKD disguised her CDI prior to transplantation. A previous intracerebral insult from an aneurysmal bleed is the likely cause of her vasopressin deficiency.

• Authors: David D W Kim, Ian M Holdaway
• Journal: Pituitary (Pituitary) Vol. 15 Issue 1 Pg. 106-9 (Mar 2012) ISSN: 1573-7403 [Electronic] United States
• PMID: 20821268 (Publication Type: Case Reports, Journal Article)

Topics

• Diabetes Insipidus (diagnosis)
• Female
• Humans
• Kidney Transplantation
• Middle Aged