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Brain, Vol. 110, No. 3, 737-746, 1987
© 1987 Guarantors of Brain

research-article

NEUROHYPOPHYSEAL PEPTIDE FUNCTION DURING EARLY POSTOPERATIVE DIABETES INSIPIDUS

JONATHAN R. SECKL1,, DAVID B. DUNGER2 and STAFFORD L. LIGHTMAN1

1From the Department of Medicine, Charing Cross and Westminster Medical School, Westminster Hospital Great Ormond Street, London 2From the Hospital for Sick Children Great Ormond Street, London

Correspondence to: Correspondence to: Dr J. R. Seckl, Charing Cross and Westminster Medical School, Westminster Hospital, Page Street, London SW1P 2AP.

Neurohypophyseal function has been investigated in 11 children undergoing pituitary or suprasellar surgery. All had corticosteroid and thyroxine replacement; 9 developed diabetes insipidus (DI) within 1–12 h of operation. At the onset of DI, the plasma vasopressin (AVP) concentration was 3.9 ±1.2 pmol/1, considerably higher values usually associated with cranial DI (< 0.9 pmol/1). AVP fell significantly to 1.1 ± 0.2 pmol/1 by the second day of DI. There was a similar change of levels of the AVP prohormone/carrier peptide, neurophysin I, but plasma oxytocin did not change significantly. High performance liquid chromatography of plasma at the onset of DI revealed a major peak that coeluted with synthetic AVP and two smaller peaks of AVP immunoreactivity. Seven patients required very large doses of desamino-8-D-arginine vasopressin (DDAVP) during the first day; 4 needed smaller doses on day 2. Water deprivation tests were performed on days 6 and 14 after operation in 5 patients with prolonged DI (2 with a tripleresponse). There were no differences in plasma AVP on the two occasions but urinary AVP excretion rate was significantly higher on day 6 (2.4±0.8 pmol/h) than day 14 (0.7±0.3 pmol/h). It is concluded that early postoperative DI is not due to decreased levels of circulating AVP but may be related to the release of biologically inactive precursors from the damaged neurohypophysis. These may lead to renal refractoriness to AVP. There is a higher urinary AVP excretion rate on day 6 than day 14 after operation in both patients with a triple response and those with uninterrupted DI. Other factors may determine whether or not a transient resolution phase of DI occurs.

Received May 6, 1986. Revised August 29, 1986. Accepted September 2, 1986.


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