Postoperative management of diabetes insipidus in a pediatric patient with Rathke's cleft cyst undergoing transsphenoidal endonasal surgery.

Abstract

Background: Postoperative Rathke cleft cyst surgery can cause injury to the pituitary gland or impaired secretion of antidiuretic hormone (ADH), leading to central diabetes insipidus (DI). This case report describes the successful postoperative management of DI in pediatric patients with Rathke's cleft cyst who underwent transsphenoidal endonasal tumor surgery.

Case description: An 8-year-old girl with diabetes insipidus (DI) following transsphenoidal endonasal surgery for a Rathke's cleft cyst was admitted to the intensive care unit (ICU) for postoperative management. Initially, the patient received oxytocin infusion at 20 mU/min. Between the 13th and 15th hour postoperatively, urine output increased to 100-200 mL/h (5-10 mL/kgBW/h). In response, oral desmopressin therapy was initiated at a dose of 0.05 mg once daily. Twelve-hour evaluations showed stable urine output at approximately 500 mL/h (2.5 mL/kgBW/h). Based on this, the decision was made to discontinue oxytocin and prepare for transfer to the high care unit (HCU). In the HCU, urine output was monitored every 24 hours, and oral desmopressin was continued at the same dosage. On the third day of treatment, urine output increased significantly to 6400 mL/24 h (14.03 mL/kgBW/h). Consequently, the desmopressin dose was increased to 0.05 mg twice daily. This adjusted therapy was maintained. By the fifth day, urine output began to decrease, reaching 6 mL/kgBW/h.

Conclusion: Postoperative management of DI using desmopressin therapy yields favorable outcomes during both intensive care and high-care treatment in pediatric patients undergoing transsphenoidal endonasal surgery for Rathke's cleft cyst.