J Endocrinol Metab

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

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. 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.

**Table 1.** Laboratory Test Results at 1 Week Before Admission
*These values are outside the normal range.
Hematology
WBC	5,600/mm³
RBC	528 × 10⁴/mm³
Hemoglobin	14.2 g/dL
Hematocrit	44.9%
Platelet	16.3 × 10⁴/mm³
Blood Coagulation Test
International Normalized Ratio of Prothrombin Time	1.05
Blood Chemistry
Total Protein	7.7 g/dL
Albumin	4.1 g/dL
AST*	49 IU/L
ALT*	57 IU/L
LDH	223 IU/L
ALP*	321 IU/L
gGTP*	73 IU/L
Total Birirubin	0.6 mg/dL
CPK	48 IU/L
BUN	5.8 mg/dL
Cre	0.52 mg/dL
Na	141 mEq/L
K	4.4 mEq/L
Cl	96 mEq/L
CRP	0.03 mg/dL
LDL-Cholesterol*	168 mg/dL
HDL-Cholesterol	54 mg/dL
Triglyceride	138 mg/dL
FBS	98 mg/dL
HbA1c	5.2%
Serology
HBsAg	negative
HCV-Ab	negative
Anti-nuclear Antibody	< 40
Anti-mitochondrial M2 Antibody	< 6.7 U/mL
IgG	1,890 mg/dL
IgM	168 mg/dL
IgA	250 mg/dL

Table 1. Laboratory Test Results at 1 Week Before Admission

*These values are outside the normal range.

Hematology

WBC

5,600/mm³

RBC

528 × 10⁴/mm³

Hemoglobin

14.2 g/dL

Hematocrit

44.9%

Platelet

16.3 × 10⁴/mm³

Blood Coagulation Test

International Normalized Ratio of Prothrombin Time

1.05

Blood Chemistry

Total Protein

7.7 g/dL

Albumin

4.1 g/dL

AST*

49 IU/L

ALT*

57 IU/L

LDH

223 IU/L

ALP*

321 IU/L

gGTP*

73 IU/L

Total Birirubin

0.6 mg/dL

CPK

48 IU/L

BUN

5.8 mg/dL

Cre

0.52 mg/dL

141 mEq/L

4.4 mEq/L

96 mEq/L

CRP

0.03 mg/dL

LDL-Cholesterol*

168 mg/dL

HDL-Cholesterol

54 mg/dL

Triglyceride

138 mg/dL

FBS

98 mg/dL

HbA1c

5.2%

Serology

HBsAg

negative

HCV-Ab

negative

Anti-nuclear Antibody

< 40

Anti-mitochondrial M2 Antibody

< 6.7 U/mL

IgG

1,890 mg/dL

IgM

168 mg/dL

IgA

250 mg/dL

**Table 2.** Plasma Hormone Concentrations on the First Postoperative Day
	Measured Value	Normal 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.
GH	1.02 ng/mL	0.28 - 1.64
PRL	9.57 ng/mL	6.12 - 30.54
ACTH	15.8 pg/mL	7.2 - 63.3
Cortisol	20.5 mg/mL*	4.0 - 18.3
TSH	1.24 pg/mL	0.43 - 3.78
Free T3	2.4 pg/mL	2.1 - 4.1
Free T4	1.2 ng/dL	1.0 - 1.7
PRA	3.5 ng/mL/hr*	0.2 - 2.7
Aldosterone	225 pg/mL*	30 -159

Table 2. Plasma Hormone Concentrations on the First Postoperative Day

Measured Value

Normal 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.

1.02 ng/mL

0.28 - 1.64

PRL

9.57 ng/mL

6.12 - 30.54

ACTH

15.8 pg/mL

7.2 - 63.3

Cortisol

20.5 mg/mL*

4.0 - 18.3

TSH

1.24 pg/mL

0.43 - 3.78

Free T3

2.4 pg/mL

2.1 - 4.1

Free T4

1.2 ng/dL

1.0 - 1.7

PRA

3.5 ng/mL/hr*

0.2 - 2.7

Aldosterone

225 pg/mL*

30 -159

**Table 3.** Results of Vasopressin Test
	Plasma Osmorality*	Urinary Osmorality*
AVP, arginine vasopressin. *Units: mOsm/kg.
Pre-administration	286	165
2 hour after AVP Administration	284	512

Table 3. Results of Vasopressin Test

Plasma Osmorality*

Urinary Osmorality*

AVP, arginine vasopressin. *Units: mOsm/kg.

Pre-administration

286

165

2 hour after AVP Administration

284

512