Cerebral salt wasting syndrome in a case of craniopharyngiom
Published in the Indian Journal of Anaesthesia, the authors report an intriguing case of the Cerebral salt wasting syndrome (CSWS) that occurred in a case of craniopharyngioma and underwent a prolonged course.

CSWS is defined by development of natriuresis, hyponatremia and subsequent hypovolemic dehydration in patients with intracranial disorders.

Classical causes of the syndrome are traumatic brain injury, stroke, subarachnoid haemorrhage and brain tumour. This syndrome has been reported following pituitary surgery and also in a case of meningoencephalitis.

Association of CSWS with craniopharyngioma is a rare entity, but not entirely a new finding. Clinical presentation of CSWS is similar to syndrome of inappropriate secretion of anti-diuretic hormone (SIADH), but differential diagnosis is essential for prescribing appropriate therapy.

A 45-year-old male complained of moderate degree headache for 15 days. Magnetic resonance imaging of brain revealed that he had sellar-suprasellar space occupying lesion (24 mm × 20 mm × 26 mm), predominantly solid in nature, without hydrocephalus, suggesting craniopharyngioma.

While waiting for elective surgical removal of that lesion, he became drowsy and admitted in our hospital. He was a patient of known hypothyroidism and was on oral thyroxin (0.1 mg daily). There was no history of convulsion or localising neurological deficit and patient was non-diabetic and non-hypertensive.

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