Glucocorticoid-Induced Central Diabetes Insipidus in a Case of Malignant Lymphoma.

Abstract

A 37-year-old man was diagnosed as malignant lymphoma infiltrating in the central nervous system with hypopituitrism and secondary glucocorticoid deficiency. In this case, plasma arginine vasopressin (AVP) increased, but glucocorticoid administration decreased plasma AVP and increased urine volume with a reduction in urinary osmolality, indicative of the presence of glucocorticoid-induced diabetes Insipidus. At the terminal stage, plasma AVP did not increase in response to the withdrawal of glucocoticoid and urine volume remained decreased, suggesting the presence of masked diabetes insipidus. Autopsy showed an infiltration of lymphoid cells around the cerebral ventricles and necrosis in the hypothalamo-hypophyseal system. These findings suggested that glucocorticoid might centrally play an important role in the regulation of AVP release, and its deficiency potentiated AVP release.AVP ; leukemia ; hypopituitarism ; hyponatremia ; hypernatremia It is well known that leukemia and chronic granulomatous diseases may infiltrate in the brain, impairing the hypothalamo-hypophyseal system, thereby inducing central diabetes Insipidus and hypopituitarism.However, the incidence of central diabetes insipidus complicated in leukemia and lymphoma has been reported to be relatively low (Williams et al. 1958;Miller and Campbell 1971). To our knowledge, there have been only a few cases with central diabetes insipidus

Unusual presentation of lung carcinoma with pituitary metastasis: a challenging diagnosis and sodium management dilemmas

“…Hence, patients with adrenocorticotropic hormone deficiency will have increased tonic ADH activity and subsequently reduced capacity for free-water excretion. When their patient had steroid accumulation, the ability to excrete free water was restored ( Huang et al 2005 , Ohta et al 2006 ). Therefore, in our patient, classical features of DI developed soon after commencing dexamethasone.…”

Competing interests in a lung cancer with metastasis to the pituitary gland: syndrome of inappropriate ADH secretion versus diabetes insipidus

“…A combined diagnosis of DI and SIADH, as in the case presented here, was not reached without careful consideration of other possible diagnoses. In cases of hypopituitarism, it has been reported that low cortisol levels seen in ACTH deficiency can mask symptoms of DI [ 9 , 10 ]. Cortisol has a direct inhibitory effect on endogenous ADH secretion; hence, ACTH deficiency increases tonic ADH activity, reducing the capacity for excretion of free water.…”

Weight loss and hyponatraemia

“…[5][6][7] Plasma concentration of arginine vasopressin thus increases in patients with glucocorticoid deficiency, which may lead to hyponatraemia that mimics syndrome of inappropriate antidiuresis. 8 Steroid replacement inhibits synthesis of arginine vasopressin, which corrects the hyponatraemia 8 or, as in this case, unmasks central diabetes insipidus.…”