Central Diabetes Insipidus after Syndrome of Inappropriate Antidiuretic Hormone Secretion with Severe Hyponatremia in a Patient with Rathke's Cleft Cyst

Intern Med. 2022 Jan 15;61(2):197-203. doi: 10.2169/internalmedicine.6608-20. Epub 2021 Jul 10.

Abstract

A 49-year-old man developed severe hyponatremia associated with transient headache and was diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Fluid restriction and sodium supplementation corrected the hyponatremia. However, several days later, the patient exhibited hypernatremia with thirst and polyuria. A detailed examination indicated central diabetes insipidus (CDI) with an intrasellar cystic lesion indicative of Rathke's cleft cyst (RCC). A case of RCC exhibiting headache, hyponatremia, and subsequent hypernatremia has been reported. Our case shows that CDI may appear after SIADH in patients with RCC, especially in those with serum sodium levels that unexpectedly increase rapidly beyond the reference range.

Keywords: Rathke's cleft cyst; arginine vasopressin; central diabetes insipidus; desmopressin; headache; syndrome of inappropriate antidiuretic hormone secretion.

Publication types

  • Case Reports

MeSH terms

  • Central Nervous System Cysts* / complications
  • Central Nervous System Cysts* / diagnosis
  • Diabetes Insipidus* / complications
  • Diabetes Insipidus* / diagnosis
  • Diabetes Insipidus, Neurogenic* / complications
  • Diabetes Insipidus, Neurogenic* / diagnosis
  • Diabetes Mellitus*
  • Humans
  • Hyponatremia* / diagnosis
  • Hyponatremia* / etiology
  • Inappropriate ADH Syndrome* / complications
  • Inappropriate ADH Syndrome* / diagnosis
  • Male
  • Middle Aged
  • Vasopressins

Substances

  • Vasopressins