{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:12Z","timestamp":1784557032347,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>We describe and characterise the case of a 26-year-old female undergoing surgery for a right-sided sinonasal alveolar rhabdomyosarcoma who developed profound, transient arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus (DI)) associated with anaesthesia. In this case report, we characterise the development of AVP-D with serial copeptin and paired urine and serum osmolality measurements. Based on the anaesthetic agent\u2019s profile and the literature, we attribute this presentation to propofol exposure. We present a description of the literature on anaesthesia-associated DI as well as poignant learning points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Exposure to anaesthetic agents is a rare cause of self-limited but sudden and profound arginine vasopressin deficiency (AVP-D) or arginine vasopressin resistance (AVP-R).<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Sevoflurane has been associated with AVP-R and propofol with AVP-D, although the responsible agent may be difficult to identify.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Differentiation of AVP-R and AVP-D can be made based on copeptin concentration, where available, or clinical response to desmopressin.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Whilst the patient is anaesthetised, intravenous fluid replacement should be targeted to match urine output until the patient is able to drink to thirst. This should be clearly communicated to staff and the patient.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Rapid resolution of AVP-R\/AVP-D when the causative agent is discontinued has been reported with both propofol and sevoflurane. As such, switching the agent used to maintain anaesthesia may terminate increased urine output in a clinically meaningful timeframe.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-24-0083","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T13:52:42Z","timestamp":1730296362000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Propofol-induced transient arginine vasopressin deficiency"],"prefix":"10.1530","volume":"2024","author":[{"given":"Michael D","family":"Luppino","sequence":"first","affiliation":[{"name":"Flinders University, Bedford Park, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huyen","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Southern Adelaide Diabetes and Endocrine Service, Flinders Medical Centre, Bedford Park, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Smale","sequence":"additional","affiliation":[{"name":"Southern Adelaide Diabetes and Endocrine Service, Flinders Medical Centre, Bedford Park, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Madigan","sequence":"additional","affiliation":[{"name":"Department of Anaesthetic, Flinders Medical Centre, Bedford Park, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morton G","family":"Burt","sequence":"additional","affiliation":[{"name":"Flinders University, Bedford Park, South Australia, Australia"},{"name":"Southern Adelaide Diabetes and Endocrine Service, Flinders Medical Centre, Bedford Park, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8959-5239","authenticated-orcid":true,"given":"Mahesh M","family":"Umapathysivam","sequence":"additional","affiliation":[{"name":"Southern Adelaide Diabetes and Endocrine Service, Flinders Medical Centre, Bedford Park, South Australia, Australia"},{"name":"University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Journal of Neuroendocrinology","first-page":"297","article-title":"Magnetic resonance imaging of the hypothalamic-neurohypophyseal system","volume":"16","author":"Fujisawa","year":"2004","unstructured":"Fujisawa I. Magnetic resonance imaging of the hypothalamic-neurohypophyseal system. Journal of Neuroendocrinology 2004 16 297\u2013302. (https:\/\/doi.org\/10.1111\/j.0953-8194.2004.01183.x)"},{"key":"bib2","series-title":"New England Journal of Medicine","first-page":"428","article-title":"A copeptin-based approach in the diagnosis of diabetes insipidus","volume":"379","author":"Fenske","year":"2018","unstructured":"Fenske WRefardt JChifu ISchnyder IWinzeler BDrummond JRibeiro-Oliveira AJrDrescher TBilz SVogt DR, et al. A copeptin-based approach in the diagnosis of diabetes insipidus. New England Journal of Medicine 2018 379 428\u2013439. (https:\/\/doi.org\/10.1056\/NEJMoa1803760)"},{"key":"bib3","series-title":"Journal of Clinical Anesthesia","first-page":"466","article-title":"Diabetes insipidus associated with propofol anesthesia","volume":"20","author":"Kassebaum","year":"2008","unstructured":"Kassebaum NHairr JGoldsmith WBarwise J & Pandharipande P. Diabetes insipidus associated with propofol anesthesia. Journal of Clinical Anesthesia 2008 20 466\u2013468. (https:\/\/doi.org\/10.1016\/j.jclinane.2008.04.013)"},{"key":"bib4","series-title":"Journal of Clinical Anesthesia","first-page":"679","article-title":"Propofol and diabetes insipidus","volume":"26","author":"Soo","year":"2014","unstructured":"Soo JGray J & Manecke G. Propofol and diabetes insipidus. Journal of Clinical Anesthesia 2014 26 679\u2013683. (https:\/\/doi.org\/10.1016\/j.jclinane.2014.02.012)"},{"key":"bib5","series-title":"Anesthesiology","first-page":"167","article-title":"The mechanism of inhibitory actions of propofol on rat supraoptic neurons","volume":"91","author":"Inoue","year":"1999","unstructured":"Inoue YShibuya IKabashima NNoguchi JHarayama NUeta YSata TShigematsu A & Yamashita H. The mechanism of inhibitory actions of propofol on rat supraoptic neurons. Anesthesiology 1999 91 167\u2013178. (https:\/\/doi.org\/10.1097\/00000542-199907000-00025)"},{"key":"bib6","series-title":"A&A Practice","first-page":"155","article-title":"Complete nephrogenic diabetes insipidus after prolonged sevoflurane sedation: a case report of 3 cases","volume":"12","author":"Cabibel","year":"2019","unstructured":"Cabibel RGerard LMaiter DCollin V & Hantson P. Complete nephrogenic diabetes insipidus after prolonged sevoflurane sedation: a case report of 3 cases. A&A Practice 2019 12 155\u2013159. (https:\/\/doi.org\/10.1213\/XAA.0000000000000871)"},{"key":"bib7","series-title":"British Journal of Anaesthesia","first-page":"e73","article-title":"Nephrogenic diabetes insipidus associated with prolonged sedation with sevoflurane in the intensive care unit","volume":"122","author":"L\u2019Heude","year":"2019","unstructured":"L\u2019Heude MPoignant SElaroussi DEspitalier FFerrandiere M & Laffon M. Nephrogenic diabetes insipidus associated with prolonged sedation with sevoflurane in the intensive care unit. British Journal of Anaesthesia 2019 122 e73\u2013e75. (https:\/\/doi.org\/10.1016\/j.bja.2019.02.009)"},{"key":"bib8","series-title":"British Journal of Anaesthesia","first-page":"734","article-title":"Sevoflurane anaesthesia causes a transient decrease in aquaporin-2 and impairment of urine concentration","volume":"83","author":"Morita","year":"1999","unstructured":"Morita KOtsuka FOgura TTakeuchi MMizobuchi SYamauchi TMakino H & Hirakawa M. Sevoflurane anaesthesia causes a transient decrease in aquaporin-2 and impairment of urine concentration. British Journal of Anaesthesia 1999 83 734\u2013739. (https:\/\/doi.org\/10.1093\/bja\/83.5.734)"},{"key":"bib9","series-title":"AANA Journal","first-page":"47","article-title":"Polyuria with sevoflurane administration: a case report","volume":"79","author":"Schirle","year":"2011","unstructured":"Schirle L. Polyuria with sevoflurane administration: a case report. AANA Journal 2011 79 47\u201350."},{"key":"bib10","series-title":"European Journal of Endocrinology","first-page":"845","article-title":"Effect of exogenous glucocorticoid on osmotically stimulated antidiuretic hormone secretion and on water reabsorption in man.","volume":"155","author":"B\u00e4hr","year":"2006","unstructured":"B\u00e4hr VFranzen NOelkers WPfeiffer AF & Diederich S. Effect of exogenous glucocorticoid on osmotically stimulated antidiuretic hormone secretion and on water reabsorption in man. European Journal of Endocrinology 2006 155 845\u2013848. 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