Adipsic diabetes insipidus patient in postoperative pituitary macroadenoma

Adipsic diabetes insipidus is a rare condition secondary to injury to osmoreceptors in the anterior hypothalamic area. Only two cases have been published secondary to pituitary tumor surgery.

A 43-year-old man, postoperative of a non-functioning pituitary macroadenoma invading the third ventricle and compressing the hypothalamus. Reoperated for headache and rhinorrhachia, developing diabetes insipidus in the postoperative period was discharged with 20 μg/day nasal desmopressin. He came again due to sensorial disorder and hypernatremia, managing to control with intravenous hydration and desmopressin. It presents with recurrence of hypernatremia every time intravenous hydration is suspended and taken orally. With high sodium levels, there is an absence of thirst. A diagnosis of adipsic diabetes insipidus is made, indicating supervised administration of water orally with favorable evolution.

Adipsic diabetes insipidus is a rare variant of central diabetes insipidus caused by damage to osmoreceptors in the hypothalamus. It manifests with absence of perception of thirst, hypernatremia and polyuria. Its management is complex and requires strict control of the water balance and adherence to treatment.