Diabetes insipidus no pós-operatório: revisão narrativa sobre Fisiopatologia, diagnóstico e manejo clínico

Abstract

Central diabetes insipidus, currently defined as arginine vasopressin deficiency is a rare condition in the gernal population but relatively frequent in specific settings, particularly after sellar and suprasellar surgery. In this context, AVP-D is associated with increased morbidity, need for intensive monitoring and impact on length of hospital stay. This study is a narrative review of the literature on postoperative diabetes insipidus, focusing on epidemiology, pathogenesis, clinical presentation, diagnosis and management. A literature search was performed in PubMed, SciELO and UpToDate using the terms “diabetes insipidus”, “arginine vasopressin deficiency”, “postoperative” and “polyuria”. Reviews, original studies and case reports published up to 2025 were considered, and eight articles most closely related to the topic were selected.The reviewed data show that the incidence of postoperative DI varies according to tumor type and degree of pituitary stalk manipulation, with higher rates in craniopharyngiomas, Rathke’s cleft cysts and large pituitary adenomas. Pathogenesis reflects a spectrum of damage to the hypothalamic–pituitary– neurohypophyseal axis, accounting for transient and permanent forms, as well as the classical triphasic pattern. Diagnosis relies on the identification of hypotonic polyuria associated with hyperosmolality/hypernatremia, using simple and practical criteria, such as those proposed by De Vries et al., which help distinguish DI from other common causes of postoperative polyuria.Management is based on strict monitoring of fluid balance and serum electrolytes, encouragement of thirst-driven oral fluid intake whenever feasible, and judicious use of desmopressin on an “as-needed” basis, in order to reduce the risk of iatrogenic hyponatremia and to detect early transitions to SIADH. In conclusion, standardized institutional protocols and a multidisciplinary approach are essential to optimize diagnosis and treatment of postoperative diabetes insipidus, thereby improving patient safety and clinical outcomes.