Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
Journal website http://www.jofem.org

Case Report

Volume 3, Number 1-2, April 2013, pages 41-46


Central Diabetes Insipidus Diagnosed After Gynecologic Surgery: A Case Report

Figures

Figure 1.
Figure 1. Pituitary T1-weighted magnetic resonance images of our patient (A) and a healthy young woman (B). In the young healthy woman, there is a hyperintense signal in the region of the posterior lobe of the pituitary gland (white arrow); this was absent in our patient. There was no thickening of the pituitary stalk or abnormality of the anterior lobe of the pituitary gland.
Figure 2.
Figure 2. Hypertonic saline infusion test. The patient was given an intravenous infusion of 5% saline solution at 0.05 mL/kg/min for 120 min. Her arginine vasopressin (AVP) level remained low (•). The dotted lines indicate the normal range of arginine vasopressin concentration according to plasma osmolarity.

Tables

Table 1. Laboratory Test Results at 1 Week Before Admission
 
*These values are outside the normal range.
Hematology
  WBC5,600/mm3
  RBC528 × 104/mm3
  Hemoglobin14.2 g/dL
  Hematocrit44.9%
  Platelet16.3 × 104/mm3
Blood Coagulation Test
  International Normalized Ratio of Prothrombin Time1.05
Blood Chemistry
  Total Protein7.7 g/dL
  Albumin4.1 g/dL
  AST*49 IU/L
  ALT*57 IU/L
  LDH223 IU/L
  ALP*321 IU/L
  gGTP*73 IU/L
  Total Birirubin0.6 mg/dL
  CPK48 IU/L
  BUN5.8 mg/dL
  Cre0.52 mg/dL
  Na141 mEq/L
  K4.4 mEq/L
  Cl96 mEq/L
  CRP0.03 mg/dL
  LDL-Cholesterol*168 mg/dL
  HDL-Cholesterol54 mg/dL
  Triglyceride138 mg/dL
  FBS98 mg/dL
  HbA1c5.2%
Serology
  HBsAgnegative
  HCV-Abnegative
  Anti-nuclear Antibody< 40
  Anti-mitochondrial M2 Antibody< 6.7 U/mL
  IgG1,890 mg/dL
  IgM168 mg/dL
  IgA250 mg/dL

 

Table 2. Plasma Hormone Concentrations on the First Postoperative Day
 
Measured ValueNormal Range
ACTH, adrenocorticotropic hormone; AVP, arginine vasopressin; GH, growth hormone; PRA, plasma renin activity; PRL, prolactin; TSH, thyroid-stimulating hormone. * These values are outside the normal range.
GH1.02 ng/mL0.28 - 1.64
PRL9.57 ng/mL6.12 - 30.54
ACTH15.8 pg/mL7.2 - 63.3
Cortisol20.5 mg/mL*4.0 - 18.3
TSH1.24 pg/mL0.43 - 3.78
Free T32.4 pg/mL2.1 - 4.1
Free T41.2 ng/dL1.0 - 1.7
PRA3.5 ng/mL/hr*0.2 - 2.7
Aldosterone225 pg/mL*30 -159

 

Table 3. Results of Vasopressin Test
 
Plasma Osmorality*Urinary Osmorality*
AVP, arginine vasopressin. *Units: mOsm/kg.
Pre-administration286165
2 hour after AVP Administration284512