scholarly journals Pengelolaan Central Diabetes Insipidus Pasca Cedera Kepala Berat

2019 ◽  
Vol 8 (2) ◽  
pp. 99-104
Author(s):  
Bona Akhmad Fithrah ◽  
Marsudi Rasman ◽  
Siti Chasnak Saleh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Central Diabetes Insipidus ◽  
Young Generation ◽  
Posterior Pituitary ◽  
Challenging Problem ◽  
Mortality And Morbidity ◽  
Post Traumatic

Cedera otak traumatika adalah salah satu penyebab kematian dan kesakitan tersering pada kelompok masyarakat muda. Hasil akhir dari cedera kepala berat dapat menyebabkan gangguan kognitif, perilaku, psikologi dan sosial. Salah satu konsekuensi dari cedera kepala berat adalah terjadinya disfungsi hormonal baik dari hipofise anterior maupun posterior. Angka kejadian disfungsi hormonal ini sekitar 20-50%. Salah satu yang paling menantang dan sering terjadi adalah diabetes insipidus (DI) dan Syndrome inappropriate antidiuretic hormone (SIADH). Angka kejadian diabetes insipidus pasca cedera kepala diduga sebesar 1-2,9% dengan berbagai tingkatannya. Pada beberapa kasus bersifat sementara tapi beberapa kasus terjadi bersifat menetap. Pada laporan kasus ini akan dibawakan sebuah kasus diabetes insipidus pasca cedera kepala berat. Pasien mengalami cedera kepala berat, hingga dilakukan decompressive craniectomi dan trakeostomi. Untuk perawatan lanjutan pasien dirujuk ke Jakarta. Saat menjalani terapi lanjutan ini pasien terdiagnosis diabetes insipidus Pada kasus ini diabetes insipidus tidak timbul langsung setelah cedera kepala tetapi baru timbul lebih kurang satu bulan setelah cedera kepala. Diabetes insipidus dikelola dengan menggunakan desmopressin spray dan oral disamping mengganti cairan yang hilang. Pada kasus ini desmopressin sempat di stop sebelum akhirnya diberikan terus menerus dan pasien diterapi sebagai diabetes insipidus yang menetap. Managing Central Diabetes Insipidus in Post Severe Head Injury PatientAbstractTraumatic brain injury is the cause of mortality and morbidity in society mostly in male-young generation. The last outcome of traumatic brain injury might be deficit in cognitive, behavioral, psychological and social. the consequences of traumatic brain injury might be hormonal disfunction from anterior and posterior pituitary. The incidence around 20-50%. The most challenging problem is diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone (SIADH). The incident of post traumatic diabetes insipidus around 1-2,9% with several degree. In certain case its only occurred transiently but some report it could be permanent. In this case report will find one case post traumatic diabetes insipidus. This pasien had severe traumatic brain injury and underwent decompressive craniectomy and tracheostomy. For further therapy patient was referred to Jakarta. In this further treatment patient diagnosed with diabetes insipidus. Diabetes insipidus doesn’t occurred since the first day of injury but occurred almost one month after. Diabetes insipidus managed with desmopressin spray and oral beside replace water loss. For a few days desmopressin stop but diabetes insipidus occurred again so desmopressin given daily both spray and oral and the patient had therapy as diabetes insipidus permanent. 

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

2018 ◽  
pp. bcr-2018-226725 ◽  
Author(s):  
Ansha Goel ◽  
Freba Farhat ◽  
Chad Zik ◽  
Michelle Jeffery
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Central Diabetes Insipidus ◽  
Pituitary Stalk ◽  
Diagnostic Tools ◽  
Individual Stage ◽  
Intracranial Surgery

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.

scholarly journals Successful Treatment of Transient Central Diabetes Insipidus following Traumatic Brain Injury in a Dog

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Catriona Croton ◽  
Sarah Purcell ◽  
Andrea Schoep ◽  
Mark Haworth
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Successful Treatment ◽  
Serum Sodium ◽  
Rapid Onset ◽  
Central Diabetes Insipidus ◽  
The Other ◽  
Clinical Progression ◽  
First Report

An 11-year-old female spayed Maltese presented comatose, half an hour after vehicular trauma, and was treated for traumatic brain injury and pulmonary contusions. The dog developed severe hypernatremia within six hours of presentation, which responded poorly to the administration of five percent dextrose in water. As central diabetes insipidus was suspected, desmopressin was trialled and resolution of hypernatremia was achieved six days later. Transient trauma-induced central diabetes insipidus has been described previously in two dogs; in the first, serum sodium concentrations were evaluated three days after injury and the other developed hypernatremia seven days after injury. To the authors’ knowledge, this is the first report of rapid onset, transient, and trauma-induced central diabetes insipidus in a dog that encompasses the complete clinical progression of the syndrome from shortly after injury through to resolution.

scholarly journals Acute and Chronic Posterior Pituitary Insufficiency Among Traumatic Brain Injury Patients at a Tertiary Care Center

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A623-A623
Author(s):  
Imtiyaz Ahmad Bhat ◽  
Moomin Hussain Bhat ◽  
Shariq Rashid Masoodi ◽  
Javid Ahmad Bhat ◽  
Zafar A Shah ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Diabetes Insipidus ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Posterior Pituitary ◽  
Urinary Osmolality ◽  
Pituitary Dysfunction

Abstract Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Disorders of salt and water balance are the most commonly recognized medical complications in the immediate post-TBI period and contribute to early morbidity and mortality. Objective: We aimed to evaluate the prevalence of acute (during hospital stay) and chronic posterior pituitary dysfunction in patients of head injury admitted at our tertiary care hospital. Study Design: Prospective, Observational study. Participants: 136 patients, attending tertiary care in North India with TBI with radiological evidence of head injury. Methodology: The severity of brain injury was assessed by the Glasgow Coma Scale (GCS), and Modified Rankin Scale (MRS) score at the time of admission. Lab measurements, apart from routine CBC and biochemical tests, included tests of serum and urinary osmolality, serum sodium, cortisol, and thyroid function test during the hospital stay. All patients were monitored closely during the hospital stay. Surviving patients were evaluated at 3, 6, and 12 months of follow-up. Urinary output and water deprivation tests were done to determine chronic posterior pituitary dysfunction. The results were compared against normative data obtained from 25 matched, healthy controls. Serum & urinary osmolality was measure by the freezing point method. Diabetes insipidus (DI) and Syndrome of inappropriate ADH secretion (SIADH) were diagnosed according to standard criteria. Results: Of 136 patients admitted, 61 (44.85%) had a mild head injury (GCS, ≤8), 47 (35.55%) had a moderate injury (GCS, 9-12), and 27 (19.85%) had a severe injury (GCS, 13-15). DI occurred in 10 patients (7.4%), while SIADH was observed in 4 patients in the immediate TBI period. Risk factors for diabetes insipidus were GCS of ≤ 8 at admission, midline shift, and surgical intervention. DI was an independent risk factor for death. There was a negative correlation between the presence of DI and GCS score (r, -0.367). Most of the patients with DI (8 out of 10) died during the hospital stay. One patient persisted to have partial diabetes insipidus and another one SIADH at three months post-TBI; both patients had recovered at six months of follow-up. No new case of DI or SIADH occurred on the follow up to 12 months. Conclusion: The incidence of acute DI in severe head injury (GCS ≤ 8) could be an indicator of the severity of TBI, and associated with increased mortality as most of our patients died during the hospital stay.

Central Diabetes Insipidus in Pediatric Severe Traumatic Brain Injury

2013 ◽  
Vol 14 (2) ◽  
pp. 203-209 ◽  
Author(s):  
Ibrahim M. Alharfi ◽  
Tanya Charyk Stewart ◽  
Jennifer Foster ◽  
Gavin C. Morrison ◽  
Douglas D. Fraser
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Severe Traumatic Brain Injury ◽  
Central Diabetes Insipidus

Intracranial pathologies associated with central diabetes insipidus in infants

2018 ◽  
Vol 31 (9) ◽  
pp. 951-958 ◽  
Author(s):  
Nader Kasim ◽  
Bindiya Bagga ◽  
Alicia Diaz-Thomas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cerebral Infarction ◽  
Diabetes Insipidus ◽  
Intraventricular Hemorrhage ◽  
Urine Osmolality ◽  
High Serum ◽  
Central Diabetes Insipidus ◽  
Intracranial Injury ◽  
Included Patient

Abstract Background Idiopathic central diabetes insipidus (CDI) has been associated with intracranial pathologies that do not involve the structural pituitary gland or hypothalamus. The objective was to study the association between non-structural hypothalamic/pituitary intracranial pathologies (NSHPIP) with CDI and to review etiologies that may be contributory to the development of CDI. Methods A retrospective query of our intra-institutional database from 2006 to 2015. Children admitted diagnosed with diabetes insipidus (DI) (ICD-9 253.5) between the ages of 0–1 year were included. Patient charts were reviewed to include those who have a documented diagnosis of CDI, hypernatremia (>145 mmol/L), high serum osmolality (>300 mOsm/kg), low urine osmolality (<300 mOsm/kg), and brain imaging reports. Diagnoses of nephrogenic DI were excluded. Results Twenty-three infant patients were diagnosed with CDI. Eleven subjects (48%) had NSHPIP. Of those, 18% had cerebral infarction, 27% had intracranial injury and hemorrhage due to traumatic brain injury, 18% had isolated intraventricular hemorrhage, and 27% had meningitis. Hospital prevalence for NSHPIP, age 0–1 year, ranged from 0.05% to 0.3%. Conclusions Rates of NSHPIP in those with CDI are higher than expected hospital rates (p<0.001), suggesting a possible association between CDI and NSHPIP.

scholarly journals Permanent central diabetes insipidus after mild head injury

2019 ◽  
Vol 12 (5) ◽  
pp. e228737 ◽  
Author(s):  
Ersen Karakilic ◽  
Serhat Ahci
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Diabetes Insipidus ◽  
Outpatient Clinic ◽  
Central Diabetes Insipidus ◽  
Bright Spot ◽  
First Year ◽  
Mild Head Injury ◽  
Severe Tbi

We report a case of a patient with mild traumatic brain injury (TBI) who was diagnosed with permanent central diabetes insipidus (DI). A 21-year-old man was admitted to our outpatient clinic with polyuria and polydipsia 1 week after a mild head injury. He was well, except for these complaints. The initial laboratory workup was consistent with DI. There was no abnormality with other laboratory and hormone values. MRI showed lack of neurohypophyseal hyperintensity with no other abnormal findings. The patient responded well to desmopressin therapy. At the first year of the diagnosis, the patient still needed to use desmopressin treatment as we concluded that DI is permanent. DI is not uncommon after TBI, but it is often seen after severe TBI. We present here an extraordinary case of developing permanent DI after mild TBI with the absence of neurohypophyseal bright spot on MRI with no other abnormal findings.

scholarly journals Osmotically volumetric urine index in early recognition and evaluation of the central diabetes insipidus correction efficiency

2021 ◽  
Vol 11 (11) ◽  
pp. 58-66
Author(s):  
Yu. Hnativ
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Early Recognition ◽  
Intensive Therapy ◽  
Hormone Secretion ◽  
Information Criterion ◽  
The Body ◽  
Central Diabetes Insipidus ◽  
Neurosurgical Patients

Purpose of the work: to develop an information criterion for early recognition and evaluation of the homeostasis correction efficiency in central diabetes insipidus. Materials and methods. 48 neurosurgical patients who underwent traumatic brain injury (21), surgery for a brain tumor (14) and stroke (13), whose course of the disease was complicated by central diabetes insipidus, have been examined. The diuresis rate and urine density (refractometrically) were studied in each of its portions excreted out of the body within an hour. According to the indicator of osmotic density and the range of urine output, an information criterion for the diagnosis of diabetes insipidus and the dynamics of its course was developed – the osmotically volumetric urine index (OVUI). Results and discussion. With physiological water input, 0.8-1.0 ml∙kg-1of urine is usually excreted from the human body within an hour. Concurrently, its specific gravity (urine density, UD) is 1012-1025. In 12 patients of the comparison group without diabetes insipidus, the OVUI index was 8.0-12.0. Central diabetes insipidus is characterized by significant homeostasis disorders: blood hypohydration and hyperosmolarity due to violation of hypothalamic-pituitary regulation of antidiuretic hormone secretion. In these conditions the osmotically volumetric urine index decreases to indicators ˂ 1.0. The criterion for the intensive therapy efficiency for homeostasis disorders in diabetes insipidus is OVUI increase above 1.0. The article presents a clinical case of timely recognition and successful correction of homeostasis in a patient with traumatic brain injury complicated by central diabetes insipidus.  Conclusions. The osmotically volumetric urine index – is an indicator that allows diagnosing diabetes insipidus in its early manifestations and timely preventing a violation of homeostasis. With the norm of OVUI at 8.0-12.0, its decrease to ˂ 1.0 indicates the presence of diabetes insipidus in the patient. Timely and adequate correction of disorders of hydration, blood osmolarity and the use of desmopressin lead to the OVUI normalization, which is a dynamic marker of the efficiency of intensive therapy of diabetes insipidus. The simplicity of the study (the possibility of carrying it out directly at the patient’s bedside), as well as the informativeness of the OVUI diagnostic and prognostic values deserve to be used in clinical practice.

Permanent central diabetes insipidus after mild traumatic brain injury

Brain Injury ◽  
2009 ◽  
Vol 23 (13-14) ◽  
pp. 1095-1098 ◽  
Author(s):  
Yi-Chun Chou ◽  
Tzu-Yuan Wang ◽  
Pey-Yu Yang ◽  
Nai-Hsin Meng ◽  
Li-Wei Chou
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Mild Traumatic Brain Injury ◽  
Central Diabetes Insipidus
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