Abstract: FR-PO0878
Recurrent Severe Hyponatremia in a Patient with Adipsic Arginine Vasopressin Deficiency After Craniopharyngioma Resection
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Odeyemi, Ayoola, New York City Health and Hospitals Metropolitan, New York, New York, United States
- Lwin-Mynn, Lin, Montefiore Wakefield Campus, New York, New York, United States
- Jovanovic, Milica, Montefiore Wakefield Campus, New York, New York, United States
- Yoo, Jinil, Montefiore Wakefield Campus, New York, New York, United States
Introduction
Adipsic arginine vasopressin deficiency (AVP-D) is a rare disorder caused by hypothalamic injury resulting in impaired vasopressin secretion and loss of thirst regulation.This makes the patients particularly susceptible to severe episodes of hypernatremia, however recurrent severe hyponatremia in adipsic AVP-D remains poorly described. We report a patient with adipsic AVP-D following craniopharyngioma resection complicated by hypothalamic injury, who experienced recurrent life-threatening hyponatremia despite desmopressin (DDAVP) therapy and prescribed fluid intake regimen.
Case Description
A 35-year-old man with craniopharyngioma following surgical resection and radiation complicated by panhypopituitarism, adipsic AVP-D, blindness and obstructive hydrocephalus requiring VP shunting, presented with altered mentation and recurrent falls. He had multiple prior admissions initially for severe hypernatremia, but more recently life threatening hyponatremic episodes requiring repeated DDAVP titration. Home medications included oral DDAVP 0.3 mg twice daily, hydrocortisone, levothyroxine, testosterone replacement, and prescribed fluid intake regimen. On admission, serum sodium 106 meq/l, serum osmolality 225 mOsm/kg, serum creatinine 0.75 mg/dl, and urine sodium 110 meq/l, urine osmolality 768 mOsm/kg. Prior admissions similarly showed elevated urine osmolarity > 350 mOsm/kg and low serum osmolality < 245 mOsm/kg. Brain CT showed no acute intracranial changes.
Given symptomatic severe hyponatremia, DDAVP was cautiously reintroduced with serial titration, strictly prescribed fluid intake and urine output monitoring. Endocrinology and Nephrology jointly managed the patient due to the narrow therapeutic window between dilutional hyponatremia and rebound hypernatremia in the setting of absent thirst regulation. Prior to discharge, family received extensive education regarding scheduled DDAVP dosing, structured fluid intake regimen, daily weight monitoring, close serum sodium check, and the potential need for institutional care to aide adherence.
Discussion
This case highlights an unusual and challenging complication of adipsic AVP-D following hypothalamic injury from craniopharyngioma resection. This reflects the delicate balance between free water intake and desmopressin dosing, requiring multidisciplinary coordinated care.