Head Injury Complicated by Diabetes Insipidus Due to Direct Injury to Hypothalamus : A Pediatric Case Report

Abstract

A 3-year-old girl was injured in a traffic accident. She suffered traumatic subarachnoid hemorrhage, pneumocephalus and multiple skull fractures including the skull base. Polyuria appeared 8 hours after injury. Urinalysis revealed that osmolarity was 122 mOsmol. The diagnosis of post-traumatic diabetes insipidus was determined, and continuous intravenous infusion of ADH (antidiuretic hormone) was started. Because interruption of ADH infusion resulted in polyuria, administration of ADH continued until the 77th hospital day. She was discharged on the 336th hospital day in a persistent vegetative state. T₂-weighted magnetic resonance imaging revealed high intensity with contrast enhancement at the hypothalamus. Endocrine findings revealed hypopituitarism due to insufficient hypothalamus function. With these findings, we concluded that direct injury to hypothalamus resulted in diabetes insipidus.