Postoperative central diabetes insipidus is a recognized complication following certain neurosurgical procedures in the region of the hypothalamus and pituitary. Depending on the type and extent of surgery, central diabetes insipidus can occur transiently in 10–20% of tumors resected using a transsphenoidal approach. It can be permanent in 60–80% of procedures necessitating palliative total hypo-physectomy. Managing central diabetes insipidus in the immediate postoperative period can be complicated due to fluctuating levels of consciousness and alterations in thirst-regulating mechanisms. Central diabetes insipidus generally manifests itself in three patterns in the postoperative period: transient diabetes insipidus, permanent diabetes insipidus, and a triphasic pattern marked by an intermediate period of antidiuresis. Making the diagnosis of diabetes insipidus is usually not complicated; other possible causes of polyuria, however, should be eliminated. Similarly, anterior pituitary insufficiency may prevent polyuria and impair the ability to make the diagnosis. The goals of therapy are aimed at maintaining normal electrolytes and maintaining sufficient in-travascular volume without inducing water overload. This is accomplished with careful fluid replacement supplemented by the judicious use of antidiuretic agents. This article will review the pathogenesis, diagnosis, and current treatment options available in managing postoperative central diabetes insipidus.