Abstract
Diabetes Insipidus (DI) following surgery to the pituitary or hypothalamus may be transient, prolonged or show a triple response.
We have investigated 11 children (1.8-15 yrs) following such surgery. Plasma vasopression (AVP), human neurophysin I (HNPI) and oxytoxin (OT) concentrations were determined at the onset of DI and daily thereafter. Water deprivation tests were performed on day 6 and 14. All had corticosteroid and thyroxine replacement.
9 patients developed early post-op DI (onset 1-12 hrs). Initial plasma AVP levels were high 3.9 ± 1.2 pmol/L and fell to 1.1 ± 0.2 pmol/L by the 2nd day (P<0.05) HNPI concentrations also fell from 0.7 ± 0.2 ng/ml to 0.2 ± 0.1 ng/ml (P<0.05) whereas plasma OT levels remained unchanged. HPLC performed on day 1 plasma revealed a major peak co-eluting with synthetic AVP and two smaller peaks of immuno reactivity.
Water deprivation tests showed no differences between patients with a triple response or uninterupted DI. Taken together, final plasma AVP concentrations on day 6 (0.8 ± 0.5 pmol/L) were similar to those on day 14 (0.5 ± 0.1 pmol/L). Maximal urinary AVP excretion on day 6 (2.4 ± 0.8 pmol/hr) was significantly (P<0.05) greater than on day 14 (0.7 ± 0.3 pmol.hr).
Early post-op DI is not due to reduced circulating AVP but may be related to release of biologically inactive precursors.
The difference in urinary AVP excretion between days 6 and 14 is insufficient to explain the resolution phase of the triple response.
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Dunger, D., Seckl, J. & Lightman, S. NEUROHYPOPHYSEAL FUNCTION IN EARLY POST-OPERATIVE DIABETES INSIPIDUS. Pediatr Res 20, 1188 (1986). https://doi.org/10.1203/00006450-198611000-00085
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DOI: https://doi.org/10.1203/00006450-198611000-00085