title: An elderly patient with sarcoidosis manifesting panhypopituitarism with central diabetes insipidus.
abstract: 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.
authors: Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Japan.
authors: Tomoko
authors: T
authors: Miyoshi
authors: Fumio
authors: F
authors: Otsuka
authors: Masaya
authors: M
authors: Takeda
authors: Kenichi
authors: K
authors: Inagaki
authors: Hiroyuki
authors: H
authors: Otani
authors: Toshio
authors: T
authors: Ogura
authors: Ken
authors: K
authors: Ichiki
authors: Tetsuki
authors: T
authors: Amano
authors: Hirofumi
authors: H
authors: Makino
mesh_terms: 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
chemical_list: D003894:Deamino Arginine Vasopressin; D013974:Thyroxine; D006854:Hydrocortisone