Question
A patient undergoes a transsphenoidal approach to remove a pituitary tumor. On the first postoperative day, his urine output is increased, serum osmolality and sodium are increased, and urine specific gravity is decreased. The patient complains of thirst. What is the most likely diagnosis?
| A. |
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
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| B. |
Diabetes insipidus
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| C. |
Nephrogenic diabetes insipidus due to hypercalcemia
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| D. |
Mineralocorticoid excess
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Show Answer
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Correct Answer � B
Explanation
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Ans. b.Diabetes insipidus
Diabetes insipidus (DI) frequently develops after pituitary surgery due to disturbing the hypothalamic-posterior pituitary axis which prevents the release of antidiuretic hormone.
This condition is usually temporary and is treated with a vasopressin synthetic replacement.
Diagnostic tests include fluid deprivation with or without desmopressin, urine specific gravity, osmolality and electrolytes, blood glucose, electrolytes, and osmolality. Brain MRI may be indicated in central DI.
Patients with diabetes insipidus have a large volume of dilute urine (up to 20 liters a day) plus excessive thirst and may experience symptoms of dehydration.
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