A CASE OF DIABETES INSIPIDUS ACCOMPANYING THIRST DISORDER ASSOCIATED WITH HYPEROSMOLAR DIABETIC COMA

Abstract

The case of a 14-year-old female who suffered from hyperosmolar diabetic coma (HODC) after resection of craniopharyngioma and during treatment for hypopituitarism and diabetes insipidus is presented. In Aug. 1989, craniopharyngioma was diagnosed and she underwent resection surgery and radiotherapy. Since then, she had been on supplemental therapy with hydrocortisone and thyroxin and desmopressin (DDAVP). On Jan. 17, 1992, she fell into HODC upon ingesting a large amount of soft drink to supplement water due to persistent polyuria. She improved quickly when supplementary fluids and insulin were administered. She had demonstrated no abnormality in glucose tolerance prior to this manifestation. Insulin therapy was deemed unnecessary after her recovery from HODC. Because of a disorder in the central nervous thirst mechaninm, she lacked the sense of thirst and concomitantly the thirst-mediated water intake in spite of elevated plasma osmolarity due to dehydration and hyperglycemia. This seemed to be the cause of her accelerating dehydration. The resulting insulin resistance then brought about her HODC. Thus, it is difficult to consider such a case of HODC as symptomatic of diabetes when no abnormality in glucose tolerance either before manifestation or after restoration can be found. It should rather be considered as a case of “dehydration hyperglycemia" and be treated as such.