Central diabetes insipidus (CDI) is characterized clinically by the presence of polyuria with the subsequent development of volume depletion and hypernatremia. In patients with dialysis-dependent end-stage renal disease (ESRD), neither of these findings can be expressed due to the absence of renal function. A 59-year-old woman with anuric ESRD of unknown etiology had been on peritoneal dialysis for 8 years prior to receiving a cadaveric allograft. Postoperatively, she developed persistent polyuria and hypernatremia. A desmopressin test confirmed the diagnosis of CDI. A magnetic resonance imaging (MRI) of the brain revealed an empty sella turcica. Maintenance therapy with intranasal desmopressin resulted in complete resolution of the polyuria. At 6-month follow-up on daily desmopressin, the patient maintains normal serum sodium levels and stable allograft function. This is a unique case of CDI from empty sella syndrome (ESS) that was unmasked only after the restoration of normal renal function following successful renal transplantation.
Keywords: central diabetes insipidus; empty sella syndrome; end-stage kidney disease; renal transplantation.