Septic Shock, Tubular Necrosis, and Central Diabetes Insipidus: A Challenging Syndrome

• Published in: Intensive care research
• Main Authors: Melegari, Gabriele, Manenti, Antonio, Arturi, Federica, Gualdi, Eugenia, Filoni, Sonia, Zelent, Gabriele, Barbieri, Alberto
• Format: Journal Article
• Language: English
• Published: 09.07.2024
• ISSN: 2666-9862; 2666-9862
• DOI: 10.1007/s44231-024-00065-8

Abstract Background The association between septic shock, acute tubular necrosis, and central diabetes insipidus is infrequent: our recent clinical observation invited us to deepen its pathophysiological features. Methods We reported an unusual case report of a young, healthy man with a septic shock, severe dehydration with a hematocrit of 70.6% caused by gastrointestinal infection and refractory renal failure, and persistent polyuria. Results The patient presented severe dehydration, hypovolemic shock with a hematocrit of 70.6%, and acute renal failure. The subsequent laboratory exams demonstrated a gastrointestinal infection of Campylobacter Upsaliensis and Helicobacter pylori. The persistent renal failure and polyuria later 20 days made it mandatory for further investigations. A Magnetic brain Resonance excluded encephalic lesions but demonstrated a posterior pituitary lobe hypointense. Conclusions This cascade of pathological events seems originated from a septic shock: the consequent increase in hematocrit and blood viscosity, estimated double the normal, with severe hypotensive shock correlated, decelerated the microcirculatory blood flow, until a proper blood stasis in the venous system. These factors caused hypoxia and possible venous thromboses, electively affecting the pituitary hypothalamic nuclei and their axons in the post-hypophysis and its portal system.