Venous thromboembolism in the setting of pediatric central diabetes insipidus: a systematic review of the literature and report of 2 cases

View More View Less
  • 1 UConn School of Medicine, Farmington, Connecticut;
  • | 2 University of Connecticut, Storrs, Connecticut;
  • | 3 Division of Neurosurgery, Connecticut Children’s, Hartford, Connecticut;
  • | 4 Department of Surgery, UConn School of Medicine, Farmington, Connecticut;
  • | 5 Department of Pediatrics, UConn School of Medicine, Farmington, Connecticut;
  • | 6 Division of Endocrinology, Connecticut Children’s, Hartford, Connecticut;
  • | 7 Division of Hematology/Oncology, Connecticut Children’s, Hartford, Connecticut
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Central diabetes insipidus (DI) is frequently identified preoperatively and/or postoperatively in patients with sellar or parasellar lesions. Early diagnosis and effective perioperative management of central DI is critical to minimize disruptions in fluid homeostasis. In particular, although venous thromboembolism (VTE) is generally less common in pediatric patients than their adult counterparts, isolated reports suggest that VTE occurs at a higher frequency in pediatric patients with central DI.

METHODS

Using the PubMed, Scopus, and Springer Link databases, the authors performed a systematic review of the literature with regard to the incidence of VTE in pediatric patients with central DI. Inclusion criteria were availability of the full text in English, diagnosis of central DI and VTE in the same patient, and pediatric age defined as ≤ 21 years. Data were reported as median and interquartile range for continuous variables and as frequencies and percentages for categorical variables. Risk of bias assessments of the individual studies were performed using the Joanna Briggs Institute Critical Appraisal Checklists for case series and case reports.

RESULTS

Of 2094 search results, 12 articles met the inclusion criteria and described a total of 17 cases of VTE in pediatric patients with central DI. Two additional patients from the authors’ institution were added to this cohort. The underlying pathologies included craniopharyngioma (n = 6), suprasellar germinoma (n = 4), epileptic encephalopathy (n = 2), pilocytic astrocytoma (n = 2), prolactinoma (n = 2), Cushing disease (n = 1), failure to thrive (n = 1), and congenital hypothalamic syndrome (n = 1). Thrombotic complications included deep vein thrombosis (n = 10 [53%]), cerebral venous sinus thrombosis (n = 6 [32%]), pulmonary embolism (n = 4 [21%]), inferior vena cava thrombosis (n = 2 [11%]), and disseminated intravascular coagulation (n = 1 [5%]). There was a 26% mortality rate.

CONCLUSIONS

VTE is a rare but potentially devastating postoperative complication that appears to have a higher incidence among patients with central DI. Although this review was limited by heterogeneous information across limited reports, pediatric neurosurgical patients with DI may benefit from more aggressive VTE surveillance and prophylaxis.

ABBREVIATIONS

AVP = arginine vasopressin; CVST = cerebral venous sinus thrombosis; DDAVP = desmopressin; DI = diabetes insipidus; DVT = deep venous thrombosis; IQR = interquartile range; IVC = inferior vena cava; PE = pulmonary embolism; POD = postoperative day; SCD = sequential compression device; VA-ECMO = venoarterial extracorporeal membrane oxygenation; VTE = venous thromboembolism.

Diagram from Behbahani et al. (pp 488–496).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Caldarelli M, Massimi L, Tamburrini G, Cappa M, Di Rocco C. Long-term results of the surgical treatment of craniopharyngioma: the experience at the Policlinico Gemelli, Catholic University, Rome. Childs Nerv Syst. 2005;21(8-9):747757.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Poretti A, Grotzer MA, Ribi K, Schönle E, Boltshauser E. Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol. 2004;46(4):220229.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Cohen M, Guger S, Hamilton J. Long term sequelae of pediatric craniopharyngioma—literature review and 20 years of experience. Front Endocrinol (Lausanne). 2011;2:81.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Wang Y, Liu W, Jia G, Li N, Jia Y. The causes of lower-extremity deep venous thrombosis in the children with cranial diseases. Int J Clin Exp Med. 2015;8(11):2201622021.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):10061012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    JBI. Checklist for systematic reviews and research syntheses. Accessed January 20, 2022. https://jbi.global/sites/default/files/2021-10/Checklist_for_Systematic_Reviews_and_Research_Syntheses.docx

    • Search Google Scholar
    • Export Citation
  • 7

    Crowley RK, Sherlock M, Agha A, Smith D, Thompson CJ. Clinical insights into adipsic diabetes insipidus: a large case series. Clin Endocrinol (Oxf). 2007;66(4):475482.

    • Search Google Scholar
    • Export Citation
  • 8

    Căpraru OM, Paşcanu I, Mărginean OC. Suprasellar germinoma with chronic hypernatremia, adipsic diabetes insipidus and hypopituitarism. Case report. Acta Endocrinol (Buc). 2014;X(2):273282.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Fleischer LM, Wilson TA, Parker MM. Hypernatremic dehydration, diabetes insipidus, and cerebral venous sinus thrombosis in a neonate: a case report. J Med Case Reports. 2007;1:66.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Furtado SV, Dash PK, Reddy K, Hegde AS. Budd-Chiari syndrome, ascites and shunt malfunction due to hyperosmolar hypernatremia in operated pediatric craniopharyngiomas: a red herring. Childs Nerv Syst. 2008;24(9):10511055.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Janus DM, Wojcik M, Zygmunt-Górska A, Wyrobek L, Urbanik A, Starzyk JB. Adipsic diabetes insipidus in pediatric patients. Indian J Pediatr. 2014;81(12):13071314.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kobayashi K, Suehiro M, Maihara T, et al. Cerebral sinovenous thrombosis and subdural hematoma as treatment-related complications in suprasellar germ cell tumor associated with adipsic diabetes insipidus. Pediatr Neurosurg. 2019;54(4):288292.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Miljic D, Miljic P, Doknic M, et al. Adipsic diabetes insipidus and venous thromboembolism (VTE): recommendations for addressing its hypercoagulability. Hormones (Athens). 2014;13(3):420423.

    • Search Google Scholar
    • Export Citation
  • 14

    Patel P, Cohen-Gadol AA, Boop F, Klimo P Jr. Technical strategies for the transcallosal transforaminal approach to third ventricle tumors: expanding the operative corridor. J Neurosurg Pediatr. 2014;14(4):365371.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Saito T, Sugai K, Takahashi A, et al. Transient water-electrolyte disturbance after hemispherotomy in young infants with epileptic encephalopathy. Childs Nerv Syst. 2020;36(5):10431048.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Sherlock M, Agha A, Crowley R, Smith D, Thompson CJ. Adipsic diabetes insipidus following pituitary surgery for a macroprolactinoma. Pituitary. 2006;9(1):5964.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Soni P, Koech H, Silva D, et al. Cerebral venous sinus thrombosis after transsphenoidal resection: a rare complication of Cushing disease-associated hypercoagulability. World Neurosurg. 2020;134:8689.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Bergadá I, Aversa L, Heinrich JJ. Peripheral venous thrombosis in children and adolescents with adipsic hypernatremia secondary to hypothalamic tumors. Horm Res. 2004;61(3):108110.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    López JA, Chen J. Pathophysiology of venous thrombosis. Thromb Res. 2009;123(suppl 4):S30S34.

  • 20

    Mishra G, Chandrashekhar SR. Management of diabetes insipidus in children. Indian J Endocrinol Metab. 2011;15(suppl 3):S180S187.

  • 21

    Mannucci PM, . Treatment of von Willebrand disease. Thromb Haemost. 2001;86(1):149153.

  • 22

    Johannesdottir SA, Horváth-Puhó E, Dekkers OM, et al. Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study. JAMA Intern Med. 2013;173(9):743752.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    van der Pas R, Leebeek FW, Hofland LJ, de Herder WW, Feelders RA. Hypercoagulability in Cushing’s syndrome: prevalence, pathogenesis and treatment. Clin Endocrinol (Oxf). 2013;78(4):481488.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Bähr V, Franzen N, Oelkers W, Pfeiffer AF, Diederich S. Effect of exogenous glucocorticoid on osmotically stimulated antidiuretic hormone secretion and on water reabsorption in man. Eur J Endocrinol. 2006;155(6):845848.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Gerber DE, Segal JB, Salhotra A, Olivi A, Grossman SA, Streiff MB. Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis. Cancer. 2007;109(2):300305.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Mandoj C, Tomao L, Conti L. Coagulation in brain tumors: biological basis and clinical implications. Front Neurol. 2019;10:181.

  • 27

    Jo JT, Schiff D, Perry JR. Thrombosis in brain tumors. Semin Thromb Hemost. 2014;40(3):325331.

  • 28

    Stokes S, Breheny P, Radulescu A, Radulescu VC. Impact of obesity on the risk of venous thromboembolism in an inpatient pediatric population. Pediatr Hematol Oncol. 2014;31(5):475480.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Chi HY, Lin CS, Hsu MH, Chan PC, Hu HH. Chronic influences of obstructive sleep apnea on cerebral venous flow. J Ultrasound Med. 2015;34(11):20432048.

  • 30

    Kondo N, Ito Y, Kawai M, et al. Obstructive sleep apnea syndrome (OSAS) presenting as cerebral venous thrombosis. Intern Med. 2009;48(20):18371840.

  • 31

    Sloop GD, De Mast Q, Pop G, Weidman JJ, St Cyr JA. The role of blood viscosity in infectious diseases. Cureus. 2020;12(2):e7090.

  • 32

    Reitsma S, Slaaf DW, Vink H, van Zandvoort MAMJ, oude Egbrink MGA. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch. 2007;454(3):345359.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Astapenko D, Dostalova V, Dostalova V, et al. Effect of acute hypernatremia induced by hypertonic saline administration on endothelial glycocalyx in rabbits. Clin Hemorheol Microcirc. 2019;72(1):107116.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Branchford BR, Betensky M, Goldenberg NA. Pediatric issues in thrombosis and hemostasis: the how and why of venous thromboembolism risk stratification in hospitalized children. Thromb Res. 2018;172:190193.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Walker SC, Creech CB, Domenico HJ, French B, Byrne DW, Wheeler AP. A real-time risk-prediction model for pediatric venous thromboembolic events. Pediatrics. 2021;147(6):e2020042325.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Cavo M, Wang W, O’Brien SH. Use of low molecular weight heparin for thromboprophylaxis in a pediatric inpatient population: reasons for use and incidence of bleeding complications. Thromb Res. 2010;125(4):370372.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37

    Panagopoulos D, Karydakis P, Noutsos G, Themistocleous M. Venous thromboembolism risk and thromboprophylaxis in pediatric neurosurgery and spinal injury: current trends and literature review. Semin Thromb Hemost. Published online October 8, 2021. doi: 10.1055/s-0041-1733959.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 121 121 121
Full Text Views 22 22 22
PDF Downloads 39 39 39
EPUB Downloads 0 0 0