Dual receptor therapy with pituitrin for spinal cord injury-induced diabetes insipidus: A propensity-matched retrospective cohort study

PURPOSE: Spinal cord injury (SCI)-induced diabetes insipidus (DI) presents a unique therapeutic challenge due to concurrent autonomic hypotension unresponsive to conventional desmopressin. This study evaluates the clinical efficacy of Pituitrin, a synthetic vasopressin analog with dual V1a/V2 receptor agonism, designed to simultaneously address antidiuretic hormone deficiency and hemodynamic instability in acute SCI-related DI. METHODS: In this retrospective propensity-matched cohort study, 317 consecutive acute SCI patients (2010 -2021) were screened, with 60 (18.9%) developing DI. Patients were stratified into a Pituitrin-treated group (2014 - 2021, n = 30) and historical controls (2010 - 2013, n = 30). Propensity score matching (1:1 nearest-neighbor, caliper = 0.2 standard deviation) adjusted for age, American Spinal Injury Association (ASIA) grade, injury level (cervical/thoracic), concurrent mild brain injury (Glasgow coma scale 13 - 15), and treatment era covariates, yielding 23 matched pairs. Post-matching groups demonstrated balanced baseline characteristics with cervical injury prevalence 95.7% and ASIA grade A/B injuries 100%. The intervention group received protocolized Pituitrin infusion (initial 1 U/h, titrated 0.5 - 5 U/h based on urine output) with fluid restriction (