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Cranial diabetes insipidus after pituitary surgery — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesCranial diabetes insipidus after pituitary surgerySCE Acute Medicine

A 69-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show post-pituitary surgery polyuria with hypernatraemia and dilute urine. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give desmopressin with careful fluid and sodium monitoring

The key discriminator is that post-pituitary surgery polyuria with hypernatraemia and dilute urine, which makes Give desmopressin with careful fluid and sodium monitoring the single best answer. Arrange urgent CT imaging is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Arrange urgent specialist referral are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology cranial DI guidance