Triphasic response of pituitary stalk injury following TBI: a relevant yet uncommonly recognised endocrine phenomenon

BMJ Case Rep. 2018 Oct 24:2018:bcr2018226725. doi: 10.1136/bcr-2018-226725.

Abstract

The triphasic response of pituitary stalk injury has previously been described in a minority of patients following intracranial surgery, however, this phenomenon can also occur after traumatic brain injury. We present the case of a 20-year-old male who experienced the triphasic response of pituitary stalk injury (central diabetes insipidus, syndrome of inappropriate antidiuretic hormone and central diabetes insipidus again) after striking his head on a concrete curb. His history and presentation highlight the importance of recognising the distinctive symptoms of each individual stage of pituitary stalk injury, and using the appropriate diagnostic tools and therapies to guide further management.

Keywords: endocrine system; medical management; pituitary disorders; trauma.

Publication types

  • Case Reports

MeSH terms

  • Antidiuretic Agents / therapeutic use
  • Brain Injuries, Traumatic / complications*
  • Deamino Arginine Vasopressin / therapeutic use
  • Diabetes Insipidus, Neurogenic / drug therapy
  • Diabetes Insipidus, Neurogenic / etiology
  • Headache Disorders / etiology
  • Humans
  • Inappropriate ADH Syndrome / diagnostic imaging
  • Inappropriate ADH Syndrome / etiology
  • Male
  • Pituitary Gland / injuries*
  • Polyuria / etiology
  • Thirst
  • Young Adult

Substances

  • Antidiuretic Agents
  • Deamino Arginine Vasopressin