Endocrine Abstracts

JOINT2337

Introduction: Diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and cerebral salt-wasting syndrome (CSWS) are observed in children with central nervous system (CNS) injuries (e.g., intracranial surgery in the hypothalamic-pituitary region, brain trauma, intracranial hemorrhage, neuroinfections, etc.). Central diabetes insipidus (DI) leads to elevated serum sodium levels and polyuria, whereas SIADH and CSWS are well-known causes of hyponatremia and polyuria in neurological patients. However, the simultaneous occurrence of DI and CSWS in pediatric patients is rarely described and often results in unfavorable outcomes.

Case Presentation: We present the case of a 15-year-old boy who suffered a traumatic brain injury in a car accident. He underwent surgical treatment for a subarachnoid hemorrhage, after which central diabetes insipidus initially developed. Treatment with Desmopressin was initiated. Later on, during follow-up, despite adequate replacement therapy with Desmopressin, persistent polyuria and symptomatic hyponatremia with natriuresis were observed. This led to the consideration of the concomitant presence of DI and CSWS. After initiating treatment with Fludrocortisone, diuresis and serum sodium levels normalized. The combined treatment was gradually discontinued, and the child was discharged in good health within 30 days.

Conclusion: The combination of central diabetes insipidus and cerebral salt-wasting syndrome is a rare phenomenon and represents a diagnostic challenge. Delayed diagnosis and inadequate management of such cases may result in poor neurological outcomes with a high mortality rate.