CASE REPORT article
Front. Endocrinol.
Sec. Neuroendocrine Science
This article is part of the Research TopicCase Reports in Anesthesiology 2025View all 5 articles
Arginine vasopressin deficiency after surgical ligation of an unruptured anterior communicating artery aneurysm – a case report and literature review
Provisionally accepted
- 1Universitetet i Oslo Institutt for medisinske basalfag, Oslo, Norway
- 2Nevrologisk avdeling, Akershus Universitetssykehus, Lørenskog, Norway
- 3Universitetet i Oslo Institutt for klinisk medisin, Oslo, Norway
- 4Oslo universitetssykehus Rikshospitalet, Oslo, Norway
- 5Endokrinologisk avdeling, Akershus Universitetssykehus, Lørenskog, Norway
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Introduction: Plasma osmolality is maintained within a narrow range by secretion of arginine vasopressin (AVP). AVP deficiency (formerly known as central diabetes insipidus) is a rare complication of surgery in the hypothalamic and pituitary region. Case description: A 50-year-old male patient developed postoperative dehydration, polyuria and cognitive impairment following surgical clip ligation of an unruptured anterior communicating artery (ACOM) aneurysm. Endocrine tests revealed moderate hypernatremia, plasma hyperosmolality and urine hypoosmolality. Magnetic resonance imaging of the brain uncovered delayed cerebral infarctions in genu rostrum of corpus callosum and bilateral oedema of fornix anterior columns. All clinical findings supported the diagnosis of central AVP deficiency, likely involving the anterior hypothalamic nuclei. Follow-up 2 months postoperatively confirmed persisting AVP deficiency and cognitive impairment. Conclusion: AVP deficiency without associated haemorrhage is exceedingly rare, with only seven cases identified in our literature review. This case highlights that postoperative AVP deficiency may present with mild or unspecific symptoms. Importantly, concurrent cognitive impairment may occur, further complicating compliance to treatment. Therefore, close postoperative monitoring is crucial for correct diagnosis and bed-side management.
Keywords: vasopressin, Insipidus, Sodium, Osmolality, Aneurysm, ACOM, Hypothalamus, MRI
Received: 08 Jul 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Gundersen, Torsheim Holmøy, Eide and Winther. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Julia K. Gundersen, juliakgundersen@hotmail.com
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