Severe rhabdomyolysis due to adipsic hypernatremia after craniopharyngioma surgery

Abstract

The association of diabetes insipidus and adipsia after craniopharyngioma surgery has high morbidity. Hypernatremia can be caused by adipsia and be aggravated by diabetes insipidus. Rhabdomyolysis rarely occurs. Case report: This is the first report of a diabetic patient with craniopharyngioma who developed diabetes insipidus and adipsia after surgery, evolving with severe hypernatremia that caused considerable rhabdomyolysis. Conclusion: The importance of the evaluation of muscle integrity when under hypernatremic states is pointed out. Although adipsia may have a simple solution through volunteer water ingestion, serious consequences such as repeated severe hypernatremia episodes and intense rhabdomyolysis with high morbidity could occur, if adipsia is not diagnosed. A associação de diabetes insipidus e adipsia após cirurgia de craniofaringioma implica em alta morbidade. Hipernatremia pode desenvolver-se devido a adipsia e ser agravada por diabetes insipidus. Rabdomiólise raramente ocorre. Descrição do caso: Esta é a primeira descrição de paciente diabético com craniofaringioma que desenvolveu diabetes insipidus e adipsia após a cirurgia, evoluindo com hipernatremia grave e conseqüente rabdomiólise maciça. Conclusão: Ressalta-se a necessidade de avaliar a integridade muscular na vigência de estados hipernatrêmicos. Apesar de apresentar solução simples, como ingestão voluntária de água, pode haver sérias conseqüências se o diagnóstico de adipsia não é realizado, como episódios repetidos de hipernatremia grave com rabdomiólise intensa e elevada morbidade. with craniopharyngioma, leading to increased morbidity. Adipsia or hypodipsia rarely occurs as a hypothalamic lesion. The association of these two osmolarity dysfunctions causes a significantly higher morbidity (1). Hypernatremia can emerge from adipsia and be aggravated by diabetes insipidus. Clinical manifestations include dehydration, muscular weakness, behavioural disturbances, apresentação de caso

Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis

“…This poor water intake in puerperium has been linked with puerperal cerebral venous thrombosis. In patients who had undergone surgery for craniopharyngioma and intracranial aneurysm, hypernatremia occurred with adypsia and the patients presented with rhabdomyolysis [14,15]. None of the patients in the present study had history of polyuria and had no hypothalamic or pituitary lesions in the MRI.…”

“…Rhabdomyolysis is reported in patients with abnormal serum electrolytes including hypokalemia, hyponatremia and hypernatremia. Hypernatremia has been associated with rhabdomyolysis and profound elevation of the serum CK levels with acute renal failure secondary to the rhabdomyolysis [14][15][16][17]. The rhabdomyolysis is hypothesized to occur from osmotic insult and disruption of the muscle membrane, leading to the release of the enzymes and myoglobin.…”

“…Experimental work in rats with induced hypernatremia showed frequent demyelination changes in thalamus, basal ganglia, tegmentum and hippocampus [12] [13]. Rhabdomyolysis with quadriparesis and raised creatine kinase (CK) levels in hypernatremia occurs due to osmotic damage to the muscle membrane [14][15][16][17][18]. Hypernatremia with cerebral imaging abnormalities and rhabdomyolysis has been reported separately.…”

Management of diabetes insipidus and adipsia in the child

“…Indeed, hypernatremia is reportedly associated with high mortality in hospitalized patients [82], and the mortality rate in hypernatremic patients further increased when they had infection [83]. Adipsic CDI patients could also have thromboembolism [84], behavioral disturbances, lethargy, coma, and muscular weakness due to rhabdomyolysis [85] and some patients reportedly died of respiratory failure at relatively young ages. In a large cohort of 149 patients with CDI, twenty-three patients with CDI and adipsia displayed a significantly higher risk of morbidity and mortality that in non-adipsic CDI [83].…”

Atualização terapêutica no tratamento dos craniofaringiomas

“…Diabetes insípido associado à adipsia, levando à hipernatremia grave com consequente rabdomiólise maciça, já foi descrito agravando a morbidade do pós--operatório de paciente com craniofaringioma (19). Raramente ocorre a recuperação total da função endó-crina após tratamento cirúrgico (4,20).…”