Sodoma Andrej M, Bulba Nicholas S, Baginski Mark, Khan Neelofar
Internal Medicine, Northwell Health, New Hyde Park, USA.
Gastroenterology, New York Institute of Techonology College of Osteopathic Medicine, Old Westbury, USA.
Cureus. 2025 Jun 30;17(6):e87060. doi: 10.7759/cureus.87060. eCollection 2025 Jun.
Traumatic brain injuries (TBIs) cause damage to the brain. Various brain structures can be vulnerable during acceleration-deceleration accidents, such as, in some cases, the pituitary organ. We present the case of a 21-year-old male with no past medical history who came to the ED of a tertiary care center after a motor vehicle accident (MVA). The patient was an unrestrained passenger ejected through the windshield of a car; he developed fluctuating sodium levels. This case demonstrates a rare occurrence of the triphasic pituitary response secondary to stalk injury, consisting of arginine vasopressin deficiency (AVP-D), syndrome of inappropriate antidiuretic hormone secretion (SIADH), and again AVP-D in a patient post traumatic brain injury (TBI). Clinical symptoms vary at each stage of the response, with management tailored accordingly. The patient in this case was admitted and diagnosed with AVP-D, initially being asymptomatic, followed shortly by hypernatremia and polyuria. In the first and last stages of AVP-D, the patient was treated with fluids and desmopressin. During the SIADH stage, the patient experienced net fluid negative and hyponatremia that was treated with fluid restriction, 3% normal saline, and conversion to salt tablets. Maintaining normal sodium levels in TBI patients is essential for preventing damage from rapid changes in osmolarity. In this case, we highlight the importance of close monitoring in the titration of sodium levels and present a successful treatment of the triphasic pituitary response secondary to stalk injury in a TBI patient.
创伤性脑损伤（TBI）会对大脑造成损害。在加速 - 减速事故中，各种脑结构都可能变得脆弱，例如在某些情况下，垂体器官。我们报告一例21岁男性病例，该患者既往无病史，在机动车事故（MVA）后被送至三级护理中心的急诊科。患者是一名未系安全带的乘客，从汽车挡风玻璃弹出；他出现了钠水平波动。该病例显示了创伤性脑损伤（TBI）患者继发于垂体柄损伤的罕见三相垂体反应，包括精氨酸血管加压素缺乏（AVP - D）、抗利尿激素分泌不当综合征（SIADH），以及再次出现的AVP - D。反应的每个阶段临床症状各不相同，治疗也相应调整。该病例中的患者入院后被诊断为AVP - D，最初无症状，随后不久出现高钠血症和多尿。在AVP - D的第一和最后阶段，患者接受补液和去氨加压素治疗。在SIADH阶段，患者出现净液体负平衡和低钠血症，通过限制液体摄入、3%生理盐水及改用盐片进行治疗。维持TBI患者的正常钠水平对于防止渗透压快速变化造成损害至关重要。在本病例中，我们强调了密切监测钠水平滴定的重要性，并展示了对一名TBI患者继发于垂体柄损伤的三相垂体反应的成功治疗。
