The inferior hypophyseal artery arises from the meningohypophyseal trunk (from the ICA cavernous segment) and supplies the neurohypophysis (posterior pituitary) and the pituitary stalk. A separate superior hypophyseal artery (from the ICA supraclinoid segment) supplies the adenohypophysis (anterior pituitary) via a portal venous system. The inferior hypophyseal artery directly vascularises the posterior pituitary where vasopressin (ADH) and oxytocin are stored and released.
The inferior hypophyseal artery and posterior pituitary blood supply are disrupted by ICA cavernous segment surgery, transsphenoidal pituitary surgery approaching the dorsal sella, and radiation injury. Damage to the neurohypophyseal blood supply causes central diabetes insipidus (DI) from ADH deficiency, presenting as polyuria and polydipsia. Transient DI is common after transsphenoidal surgery (20-30%); permanent DI affects 1-2%. The triphasic response after pituitary stalk injury (initial DI, then SIADH from uncontrolled ADH release, then permanent DI) reflects the sequential phases of neurohypophyseal dysfunction.
Pituitary stalk injury or posterior pituitary devascularisation from transsphenoidal surgery disrupts inferior hypophyseal artery supply producing central DI with massive dilute polyuria and polydipsia; the triphasic response occurs in 10% of cases and desmopressin (DDAVP) replacement provides the long-term management for permanent DI.
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