Childhood Kidney Diseases

  • 제24권1호
  • /
  • Pages.42-46
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  • 2020
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  • 2384-0242(pISSN)
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  • 2384-0250(eISSN)
대한소아신장학회 (Korean Society of Pediatric Nephrology)
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Coexistence of Central Diabetes Insipidus and Prolonged Cerebral Salt Wasting Syndrome after Brain Tumor Surgery: A Case Report

  • Lee, Ji Sun (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Baek, Hee Jo (Department of Pediatrics, Hwasoon Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Kim, Chan Jong (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Yang, Eun Mi (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School)
  • 투고 : 2020.01.29
  • 심사 : 2020.03.25
  • 발행 : 2020.04.30
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초록

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 of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, 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. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient 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.

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참고문헌

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피인용 문헌

  1. Prolonged Postoperative Pyrexia and Transient Nonnephrogenic Vasopressin-Analogue-Resistant Polyuria following Endoscopic Transsphenoidal Resection of an Infundibular Epidermoid Cyst vol.2021, 2021, https://doi.org/10.1155/2021/6690372