DOI: 10.12890/2024_005028
Long-term persistence of inappropriate antidiuretic hormone secretion following minor head injury
Authors
prossignon@yahoo.fr
Keywords
SIADH, hyponatremia, traumatic brain injury, persistent hyponatremiaAbstract
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of euvolemic hyponatremia, resulting from non-osmotic release of antidiuretic hormone (ADH). SIADH is frequently associated with neurological conditions, including traumatic brain injury (TBI). TBI-associated SIADH usually develops within days to weeks and resolves within a few weeks. We present the case of a 74-year-old man who, after a fall resulting in TBI, initially had normal sodium levels. Fifteen days later, he developed moderate-to-severe hyponatremia (120 mmol/l) and significant neurological symptoms. Treatment with urea effectively normalized his sodium levels and resolved symptoms. However, recurrent hyponatremia persisted for over six months whenever urea treatment was discontinued. This unusual duration of TBI-associated SIADH underscores the importance of long-term follow-up in the management of post-traumatic hyponatremia.
References
- Adrogué HJ, Madias NE. The Syndrome of Inappropriate Antidiuresis. N Engl J Med 2023;389:1499–1509.
- Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014;29:i1–39.
- Léveillé E, Aljassar M, Beland B, Saeedi RJ, Marcoux J. Determinants of hyponatremia following a traumatic brain injury. Neurol Sci 2022;43:3775–3782.
- van der Voort S, de Graaf J, de Blok K, Sekkat M. Persevering syndrome of inappropriate antidiuretic hormone secretion after traumatic brain injury. Neth J Med 2020;78:290–293.
- Dick M, Catford SR, Kumareswaran K, Hamblin PS, Topliss DJ. Persistent syndrome of inappropriate antidiuretic hormone secretion following traumatic brain injury. Endocrinol Diabetes Metab Case Rep 2015;2015:150070.
- Chang CH, Chuang CH, Lee CT, Liao JJ. Recurrent Hyponatremia After Traumatic Brain Injury. Am J Med Sci 2008;335:390–393.
- Kumar PD, Nartsupha C, Koletsky RJ. Delayed Syndrome of Inappropriate Antidiuretic Hormone Secretion 1 Year after a Head Injury. Ann Intern Med 2001;135:932–933.
- Agha A, Thornton E, O’Kelly P, Tormey W, Phillips J, Thompson CJ. Posterior Pituitary Dysfunction after Traumatic Brain Injury. J Clin Endocrinol Metab 2004;89:5987–5992.
- Wong LL, Verbalis JG. Systemic diseases associated with disorders of water homeostasis. Endocrinol Metab Clin North Am 2002;31:121–140.
- Wendt R, Fenves AZ, Geisler BP. Use of Urea for the Syndrome of Inappropriate Secretion of Antidiuretic Hormone: A Systematic Review. JAMA Netw Open 2023;6:e2340313.
- Soupart A, Coffernils M, Couturier B, Gankam-Kengne F, Decaux G. Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH. Clin J Am Soc Nephrol 2012;7:742.