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Case Report Volume 14 Issue 2
Unconfounded triphasic ADH response following intracranial hemorrhage: evolution from diabetes insipidus to SIADH
, Verdana">, ">Asha Sarkar, Mohit Raj Singh, Debmalya Sanyal
Received: June 02, 2026 | Published: June 26, 2026
Citation: Sarkar A, Singh MR, Sanyal D. Unconfounded triphasic ADH response following intracranial hemorrhage: evolution from diabetes insipidus to SIADH. Endocrinol Metab Int J. 2026;14(2):37-40. DOI: 10.15406/emij.2026.14.00388
Abstract
Background:Triphasic dysregulation of antidiuretic hormone (ADH), characterized by an initial diabetes insipidus (DI) phase followed by syndrome of inappropriate antidiuretic hormone secretion (SIADH) and subsequent normalization, is classically described in pituitary and neurosurgical settings but is rarely documented in spontaneous intracranial haemorrhage. Case: A 58-year-old female with chronic kidney disease and recent coronary artery bypass grafting on anticoagulation presented with intracranial haemorrhage complicated by obstructive hydrocephalus requiring external ventricular drainage. She initially developed hypernatremia (165 mmol/L) with elevated serum osmolality (363 mOsm/kg), reduced urine osmolality (178 mOsm/kg) consistent with central diabetes insipidus. This was followed by a transition phase and subsequent hyponatremia (121 mmol/L) with elevated urine sodium and osmolality, fulfilling diagnostic criteria for SIADH. Notably, only a single dose of desmopressin was administered during the clinical course. The clinical course was complicated by thrombotic manifestations with antiphospholipid antibody positivity, for which intravenous immunoglobulin (IVIG) was administered. Biochemical findings and response to fluid restriction supported true SIADH rather than IVIG-related pseudohyponatremia. Conclusion:This case demonstrates a complete triphasic ADH response in spontaneous intracranial haemorrhage without therapeutic confounding. It highlights the importance of dynamic sodium monitoring, careful phase recognition, and avoidance of misinterpretation due to treatment-related artefacts.
Keywords: intracranial hemorrhage, siadh, diabetes insipidus, hypernatremia, hyponatremia, antiphospholipid syndrome, neurocritical care
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