Polyuric-polydipsic syndrome after cranioencephalic traumatism in a patient with multiple sclerosis
Selma B Souto1,2, Joana Mesquita1,2, Marta Alves1,2, Daniel Carvalho Braga1,2, Ana Varela1,2, Elisabete Rodrigues1,2, Celestino Neves1,2, Fernanda Guerra1 & José Luís Medina1,2
Introdution: Central diabetes insipidus(CDI) is a rare disease, with multiple aetiologies such as cranioencephalic traumatism and multiple sclerosis (ME). However, the association with ME is not commonly described. The clinical suspicion must be made in the presence of polyuria and polydipsia.
Case report: Woman, 67 years-old, revealing history of ME relapsing-remitting subtype with 8 years of evolution, hypertension and dyslipidemia, medicated with interferon beta 1a, valsartan 80 mg/day and pravastatine 20 mg/day. She referred polyuria and polydipsia after frontal cranioencephalic traumatism. Her serum sodium level and urine density were normal. She was submitted to a water deprivation test that confirmed CDI (Table 1), and started nasal desmopressin therapy 5 μg/day, with clinical improvement. Pituitary resonance imaging revealed focal thickening of the stalk and absence of the posterior pituitary bright spot. Serum levels of gonadotrophines, IGF-I, PRL, TSH and ACHT were normal. The patient was submitted to an insulin hypoglycaemia, TRH and LHRH test, with normal pituitary response except for TSH. Currently, she is under nasal desmopressin therapy 20 μg/day, with clinical improvement.
Conclusion: The importance of this case report is related to the rarity of described cases of DIC caused by ME. Nevertheless, for the present case it remains to be clarified if the DIC was caused by the patient history of cranioencephalic traumatism.
Table 1 Water deprivation test.
|Times||Weight (kg)||Blood pressure (mmHg)||Pulse (bpm)||Urine osmolality (mOsm/Kg)||Serum osmolality (mOsm/Kg)||Urine debite (ml/h)|
|Desmopressin administration (intravenous 1 μg)|