Endocrine Abstracts

Background: Sarcoidosis is a multisystemic disease, the cause of which has not yet been determined. It’s characterized by the appearance of granulomas, which typically target the lungs, the lymphatic system and in rare cases, around 5-15%, changes in the nervous system are observed. Neurosarcoidosis leads to hypothalamus-pituitary axis dysfunction and the most common clinical manifestation is the onset of central diabetes insipidus.

Case report: We present the case of a 46-year-old female patient with neurosarcoidosis and changes in the hypothalamus-pituitary axis and clinical manifestation of hypopituitarism, along with a non-typical presentation of central diabetes insipidus. The diagnosis of neurosarcoidosis has not been confirmed with a biopsy due to its high risk and difficulty to access. However, according to the CT and MRI results and the clinical presentation, an intensive hormone replacement therapy was administered to reduce the clinical symptoms. What is notable about this case is the diagnosis for central diabetes insipidus, which could not be confirmed based on the clinical characteristics because of the absence of polydipsia and polyuria, as well as with the classic water deprivation test because of persistent hypernatremia, which was confirmed by excluding other potential causes of hypernatremia.

Conclusion: Neurosarcoidosis has a rich clinical presentation and is a challenge when it comes to diagnosis and treatment, particularly with patients with disorders in the hypothalamus-pituitary axis and non-typical adipsic central diabetes insipidus.

Keywords: neurosarcoidosis, central diabetes insipidus, hypernatremia