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Childhood Kidney Diseases 2020;0(0): 0
Coexistence of central diabetes insipidus and prolonged cerebral salt wasting syndrome after brain tumor surgery: a case report
Ji Sun Lee1 , Chan Jong Kim1 , Eun Mi Yang1 , Hee Jo Baek2
1Department of Pediatrics, Chonnam National University Hospital, Chonnam National University , Gwangju, Korea
2Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
Corresponding Author: Ji Sun Lee ,Tel: 010-3930-6234, Fax: 062-220-6658, Email: dkssud06@gmail.com
Received: January 29, 2020;  Accepted: March 25, 2020.
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ABSTRACT
Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria and hyponatremia. Polyuria was treated with desmopressin, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. The patients in this study still required treatment with vasopressin and fludrocortisone at 16-months after surgery. Hyponatremia in a patient with CDI may be erroneously interpreted as inadequate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.
Key words: Diabetes insipidus; Cerebral salt wasting; Hyponatremia; Polyuria
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Coexistence of Central Diabetes Insipidus and Prolonged Cerebral Salt Wasting Syndrome after Brain Tumor Surgery: A Case Report  2020 April;24(1)
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