Persistent syndrome of inappropriate antidiuretic hormone secretion following traumatic brain injury

[摘要] The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur following traumatic brain injury (TBI),but is usually transient. There are very few case reports describing chronic SIADH and all resolved within 12 months,except for one case complicated by meningo-encephalitis. Persistent symptomatic hyponatremia due to chronic SIADH waspresent for 4 years following a TBI in a previously well 32-year-old man. Hyponatremia consistent with SIADH initiallyoccurred in the immediate period following a high-speed motorbike accident in 2010. There were associated complicationsof post-traumatic amnesia and mild cognitive deficits. Normalization of serum sodium was achieved initially with fluidrestriction. However, this was not sustained and he subsequently required a permanent 1.2 l restriction to maintain nearnormal sodium levels. Multiple episodes of acute symptomatic hyponatremia requiring hospitalization occurred over thefollowing years when he repeatedly stopped the fluid restriction. Given the ongoing nature of his hyponatremia anddifficulties complying with strict fluid restriction, demeclocycline was commenced in 2014. Normal sodium levels withoutfluid restriction have been maintained for 6 months since starting demeclocycline. This case illustrates an importantlong-term effect of TBI, the challenges of complying with permanent fluid restrictions and the potential role ofdemeclocycline in patients with chronic hyponatremia due to SIADH.

[学科分类] 血液学

[关键词] Adult;Male;White;Australia;Pituitary;Neuroendocrinology;AVP;Hyponatraemia;SIADH;Traumatic brain injury;Hyponatraemia;Nausea;Malaise;Anorexia;MRI;Sodium;Osmolality;Serum osmolality;Urine osmolality;Cortisol;Fluid restriction;Demeclocycline;Antibiotics;Neurology;Rehabilitation;Surgery;Novel treatment;October;2015