P Dileep Kumar, MD; Chorthip Nartsupha, MD; Richard J. Koletsky, MD
Note: An abstract of this paper was presented at the annual meeting of the Midwestern Section, American Federation of Medical Research, 21–23 September 2000, Chicago, Illinois.
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. doi: 10.7326/0003-4819-135-10-200111200-00027
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Published: Ann Intern Med. 2001;135(10):932-933.
TO THE EDITOR:
Intracranial disease, such as trauma, tumors, infections, and neurosurgery, can cause an immediate and short-lived syndrome of inappropriate antidiuretic hormone secretion (SIADH) (1). We report a case of delayed SIADH presenting 1 year after a head injury.
A 38-year-old man had bilateral frontal lobe contusions and subarachnoid hemorrhage in May 1998 after an assault. He improved with conservative treatment. He was seen in August 1999 with generalized tonic-clonic seizures. His pulse was 55 beats/min, his blood pressure was 116/73 mm Hg, and the results of the rest of the examination were normal. Sodium level was 119 mmol/L, serum osmolality was 248 mmol/kg (normal range, 280 to 295 mmol/kg), urine sodium level was 132 mmol/L, urine osmolality was 203 mmol/kg (normal range, 300 to 1300 mmol/kg), uric acid level was 132 µmol/L (normal range, 150 to 480 to µmol/L), thyroid-stimulating hormone level was 3.88 mU/L (normal range, 0.34 to 4.82 mU/L), cortisol level at 8:00 a.m. was 510 nmol/L (normal range, 140 to 690 nmol/L), and vasopressin level was 4.9 pmol/L (normal range, 0 to 4.4 pmol/L). A computed tomographic scan of the brain showed encephalomalacia of both frontal lobes. We diagnosed SIADH and restricted fluid intake to 1 L/d. The serum sodium level increased to 132 mmol/L, and the patient had no further seizures.
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