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Case report
Isolated second-phase diabetes insipidus post-transsphenoidal surgery
  1. Annalisa Montebello1,
  2. Darryl Portelli2 and
  3. Mark Gruppetta1
  1. 1Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
  2. 2Department of General Internal Medicine, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Annalisa Montebello; a.montebello{at}


A 57-year-old woman presented with severe lethargy, dizziness and nausea 1 week after transsphenoidal resection of a growth hormone secreting pituitary adenoma. She was found to have severe hyponatremia of 115 mmol/L. Importantly, she was neurologically intact and clinically euvolaemic. Her fluid intake was restricted and her sodium levels increased to 131 mmol/L over 4 days. She made a full recovery.

She was diagnosed with isolated second-phase diabetes insipidus, a state of symptomatic hypoosmolar hyponatremia that usually occurs 7–10 days after transsphenoidal surgery. The sodium levels improve with fluid restriction.

  • metabolic disorders
  • neurosurgery

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  • Contributors AM and DP wrote up the case report together with MG’s constant review and advice.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.