Diabetes Insipidus from Neurosarcoidosis: Long-term Follow-up for More than Eight Years

Tabuena, Rollin P.; Nagai, Sonoko; Handa, Tomohiro; Shigematsu, Michio; Hamada, Kunio; Ito, Isao; Izumi, Tatsuro; Mishima, Michiaki; Sharma, Om P.

doi:10.2169/internalmedicine.43.960

Cited by 42 publications

(48 citation statements)

References 17 publications

(13 reference statements)

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“…There have been few case reports that diabetes insipidus could be cured in this situation, except for one spontaneous remission case (11). It has been considered that anterior pituitary function is difficult to restore, because hypopituitarism is not improved although the thickened pituitary stalk and enlarged pituitary gland return to their normal shapes after steroid treatment (3,12). However, a few case reports have shown that steroid therapy is able to partially improve anterior pituitary hormone secretion, which was confirmed by an endocrine provocation test (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Partial Improvement of Anterior Pituitary Deficiency Following Steroid Treatment in a Patient with Neurosarcoidosis Accompanied by Central Diabetes Insipidus

et al. 2012

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A 58-year-old woman was admitted due to visual field abnormalities, thirst, polydipsia, polyuria and fever. T1-weighted magnetic resonance imaging revealed an absence of the usual bright signal in the posterior lobe of the pituitary gland, and an enlarged pituitary gland with a thickened stalk was enhanced by the gadolinium contrast medium. Computed tomography revealed tumor lesions in the left maxillary sinus and right retroperitoneum and axillary and subclavian lymph node swelling. An endocrinological provocation test demonstrated that her pituitary endocrine function was disturbed, although her ACTH and TSH secretion was normal. The patient was histologically diagnosed with neurosarcoidosis accompanied by hypopituitarism and central diabetes insipidus upon an examination of a subclavian lymph node specimen. Six months of prednisolone treatment resulted in the disappearance of any morphological abnormalities in the pituitary gland and stalk as well as a partial improvement in her LH, FSH and GH secretions. Pituitary endocrine functions can be rescued if steroid treatment is performed under conditions that maintain several hormonal axes.

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Section: Discussionmentioning

confidence: 99%

Partial Improvement of Anterior Pituitary Deficiency Following Steroid Treatment in a Patient with Neurosarcoidosis Accompanied by Central Diabetes Insipidus

et al. 2012

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“…The therapeutic effects of corticosteroids on hypothalamo-pituitary involvement due to sarcoidosis have been proposed [19]. In general, the effectiveness to restore anterior pituitary function and diabetes insipidus is unexpected [20], although a case of neurosarcoidosis showing complete resolution of the suprasellar mass as well as recovery of concurrent hypogonadism is documented [21]. Clinical courses of sarcoidosis are varied and advanced disease with extensive granulomatous involvement leads to irreversible neurological deficit [22].…”

Section: Discussionmentioning

confidence: 99%

An Elderly Patient with Sarcoidosis Manifesting Panhypopituitarism with Central Diabetes Insipidus

et al. 2007

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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.

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“…In CNS sarcoidosis, the delay of initial treatment of steroid easily leads to the irreversible CDI (9,10). Thus the prompt diagnosis is important.…”

Section: Polyuria and Polydipsia Are Common Presenting Features Of mentioning

confidence: 99%

“…Although the prognosis of CNS sarcoidosis with/without steroid treatments is poor (9,10) (Fig. 4) (Fig.…”

Section: Polyuria and Polydipsia Are Common Presenting Features Of mentioning

confidence: 99%

Spontaneous Remission of Diabetes Insipidus Due to CNS Sarcoidosis

et al. 2009

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Diabetes Insipidus from Neurosarcoidosis: Long-term Follow-up for More than Eight Years

Cited by 42 publications

References 17 publications

Partial Improvement of Anterior Pituitary Deficiency Following Steroid Treatment in a Patient with Neurosarcoidosis Accompanied by Central Diabetes Insipidus

Partial Improvement of Anterior Pituitary Deficiency Following Steroid Treatment in a Patient with Neurosarcoidosis Accompanied by Central Diabetes Insipidus

An Elderly Patient with Sarcoidosis Manifesting Panhypopituitarism with Central Diabetes Insipidus

Spontaneous Remission of Diabetes Insipidus Due to CNS Sarcoidosis

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