Endocrine Aspects of Sarcoidosis

Diabetes insipidus from sarcoidosis confined to the posterior pituitary

“…This may cause diabetes insipidus by complete destruction of the posterior lobe and accompanying impairment of the pituitary stalk. Granulomatous diseases, such as sarcoidosis, tuberculosis and syphilis, can also infiltrate the posterior lobe or pituitary stalk to cause diabetes insipidus (1)(2)(3)5). While it is true that a definitive diagnosis of neurohypophysial lesions is only possible with histological confirmation of specimens obtained via biopsy or autopsy, one can nevertheless reach a reasonable presumptive diagnosis on the basis of associated clinical and laboratory findings in these patients.…”

“…These patients also commonly manifest hypothalamic dysfunction such as the impairment of thirst, temperature, sleep or weight regulation (16)(17)(18). Although there was an infrequency of hypopituitarism in earlier reports of patients with diabetes insipidus from neurosarcoidosis, several investigators concluded that this was due to inadequate laboratory evaluation of anterior pituitary function in those patients (1,2). Furthermore, symptoms of hypopituitarism caused by a slowly expanding granulomatous lesion are often subtle in the adult compared with the more rapid onset of symptoms of diabetes insipidus.…”

“…Patients with neuroendocrine sarcoidosis commonly have hypothalamic dysfunction and, to a lesser extent, variable involvement of the infundibulum, the pituitary gland, or both. In addition to diabetes insipidus, they often exhibit hypothalamic disturbances and anterior pituitary hormone deficiency (1)(2)(3). We report a patient with pulmonary sarcoidosis and central diabetes insipidus secondary to posterior pituitary involvement, who was notable for normal hypothalamic and anterior pituitary functions, and a complete regression of the neurohypophysial mass after corticosteroid therapy.…”

“…The therapeutic results of administration of corticosteroids to patients with hypothalamic-pituitary involvement from sarcoidosis have been disappointing, and the improvement of diabetes insipidus associated with sarcoidosis has been uniformly poor (1,3,22,23). Patients frequently show progression of the disease or failure to improve despite steroid therapy.…”

“…Endocrinopathy occurring in sarcoidosis is relatively rare, the hypothalamus and pituitary gland being the most commonly affected regions (1)(2)(3). Of the numerous symptoms attributed to neuroendocrine sarcoidosis, polyuria and polydipsia are the most frequent, as reported in 33% of patients with sarcoidosis of the central nervous system.…”