Follow up study of diabetes insipidus after surgery for craniopharyngiomas in children and adults

Abstract

A follow-up from 10 months to 9 years 2 months of 13 patients (nine children and four adults) with diabetes insipidus (DI) after microscopic surgery of craniopharyngiomas was performed. Antidiuretic hormone (ADH) and cortisol in plasma was serially measured by radioimmunoassay. Primary surgical treatment consisted of total excision of the tumor in five children, and subtotal excision of the tumor in four children and four adults. Three of the children and three of the adults received radiotherapy. No recurrences occurred. Of the nine children, three had minimal to no DI for 2 years 11 months, 11 months, and 9 months respectively after surgical treatment, whereas six had persistent DI postoperatively for 10 months to 5 years. All of the four adults had no clinically significant DI 1 to 20 months after surgery, but two died as a result of endocrine deficits in the postoperative period after 1 year 9 months and 3 years 11 months. Plasma ADH levels of six children who had clinical features of DI postoperatively were below 1.8 μU/ml. Seven cases (three children and four adults) showed low values of plasma ADH below 1.9 μU/ml, although clinical manifestations of DI had disappeared. Plasma cortisol levels of 10 cases (seven children and three adults) were below 5 μg/dl in the postoperative period. It was suggested that postoperative DI due to craniopharyngioma did not always show polyuria. It was also indicated that a long-term follow-up is necessary for the treatment of postoperative DI due to craniopharyngioma.