An elderly patient with sarcoidosis manifesting panhypopituitarism with central diabetes insipidus.
We here report a 77-year-old Japanese male who suffered general fatigue with progressive thirst and polyuria. Central diabetes insipidus was diagnosed by depletion of vasopressin secretion in response to increases in serum osmolality. Secretory responses of anterior pituitary hormones including adrenocorticotropin, thyrotropin, gonadotropins and growth hormone were severely impaired. Diffuse swelling of the infundibulum as well as lack of T1-hyperintense signal in the posterior lobe was noted by pituitary magnetic resonance imaging. The presence of bilateral hilar lymphadenopathy and increased CD4/CD8 ratio in bronchoalveolar lavage fluid was diagnostic for lung sarcoidosis. Physiological doses of corticosteroid and thyroid hormone were administered in addition to desmopressin supplementation. Complete regression of the neurohypophysial swelling was notable two years after corticosteroid replacement. Diffuse damage of anterior pituitary combined with hypothalamic involvement leading to central diabetes insipidus is a rare manifestation in such elderly patients with neurosarcoidosis.
Miyoshi
Tomoko
T
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan.
Otsuka
Fumio
F
Takeda
Masaya
M
Inagaki
Kenichi
K
Otani
Hiroyuki
H
Ogura
Toshio
T
Ichiki
Ken
K
Amano
Tetsuki
T
Makino
Hirofumi
H
D000368:Aged; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D020790:Diabetes Insipidus, Neurogenic / Q000188:drug therapy / Q000209:etiology*; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000150:complications* / Q000188:drug therapy; D008297:Male; D017565:Sarcoidosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D013974:Thyroxine / Q000627:therapeutic use
D003894:Deamino Arginine Vasopressin; D013974:Thyroxine; D006854:Hydrocortisone