Key points are not available for this paper at this time.
Abstract Disclosure: P. Sargin: None. J. Montoya: None. Several complications have been reported during the postoperative phase following craniopharyngioma resection, with electrolyte disturbances and hormonal imbalances as two of the most common during the early postoperative period. Central diabetes insipidus (DI) occurs commonly in these patients. In rare cases, patients lose their thirst response to hyperosmolarity, resulting in adipsic diabetes insipidus (ADI). Patients with ADI may develop permanent DI that is often difficult to manage even with proper treatment, leading to multiple hospitalizations, numerous comorbidities including severe hypernatremia and deep vein thrombosis (DVT), high morbidity and mortality. Panhypopituitarism is another common post-operative complication of any suprasellar mass. It is associated with multiple systemic, often life-threatening comorbidities; some are poorly understood. The intricate interplay of hormones in the pituitary gland and their diverse effects on various body systems has hindered our complete comprehension of their synergistic effects and the resulting complications. An otherwise healthy 29-year-old man with craniopharyngioma underwent resection 4 months ago at another facility. His postoperative course was complicated with central DI and panhypopituitarism and he was discharged with desmopressin, levothyroxine, and steroids. He also had a pacemaker placed due to unexplained sick sinus syndrome (SSS) that developed following surgery. He was admitted with lethargy and altered mental status, then was diagnosed with hypovolemic shock in the setting of DI with possible contributing adrenal insufficiency. Laboratory work-up showed hypernatremia (156mEq/L), thrombocytopenia (92k/uL), and macrocytic anemia (7.0g/dL) with normal coagulation factors. Further studies showed extensive occlusive DVT in both legs. A comprehensive work-up was unable to identify the source of cytopenias. After appropriate management, he was discharged home in stable condition. Two weeks later, he presented for the third time with unresponsiveness and worsening severe hypernatremia (170mEq/L). Per the family, he was refusing to drink anything at home. During this admission, the hospital course was prolonged with widely fluctuating Na levels. The diagnosis was concluded as ADI. Eventually, his Na level stabilized, family was educated on adequate water intake. In this complex case with multiple comorbidities, we are highlighting the relationship between panhypopituitarism and its association with SSS and cytopenias with no other identifiable cause. Although it is difficult to prove the causation in our case, some case reports have reported the association between ADI and DVT. The case presented highlights the complex challenges in managing these complications, emphasizing the need for comprehensive care and continuous patient education to mitigate potential adverse outcomes. Presentation: 6/1/2024
Sargin et al. (Tue,) studied this question.