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Published on: June 21, 2019
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Triphasic Response of Pituitary Stalk Injury Secondary to Traumatic Brain Injury
Andrej M Sodoma1, Nicholas S Bulba2, Mark Baginski1
1Internal Medicine, Northwell Health, New Hyde Park, USA.
Cureus
|August 1, 2025
Summary
Traumatic brain injury can cause fluctuating sodium levels due to pituitary stalk injury. This case highlights a rare triphasic pituitary response and its successful management in a TBI patient.
Area of Science:
- Neuroscience
- Endocrinology
- Trauma Surgery
Background:
- Traumatic brain injuries (TBIs) can impact various brain structures, including the pituitary gland, due to acceleration-deceleration forces.
- Pituitary dysfunction is a potential complication following TBI, affecting hormonal regulation and electrolyte balance.
Observation:
- A 21-year-old male, following a motor vehicle accident (MVA), presented with fluctuating sodium levels.
- The patient exhibited a rare triphasic pituitary response characterized by arginine vasopressin deficiency (AVP-D), syndrome of inappropriate antidiuretic hormone secretion (SIADH), and recurrent AVP-D, indicative of pituitary stalk injury.
Findings:
- The triphasic response involved initial AVP-D with asymptomatic presentation, followed by hypernatremia and polyuria.
- The subsequent SIADH phase led to hyponatremia and net fluid loss, requiring fluid restriction and saline treatment.
- The final AVP-D phase was managed with fluids and desmopressin, restoring normal sodium levels.
Implications:
- Close monitoring and tailored management of sodium levels are crucial in TBI patients to prevent complications from osmolarity shifts.
- This case underscores the importance of recognizing and treating the triphasic pituitary response following TBI-induced stalk injury.
