deamino-arginine-vasopressin and Central-Nervous-System-Diseases

Central diabetes insipidus (CDI) is an infrequent complication of neurosarcoidosis (NS). Its presentation may be masked by adrenal insufficiency (AI) and uncovered by subsequent steroid replacement. A 45-year-old woman with a history of NS presented 2 weeks after abrupt cessation of prednisone with nausea, vomiting, decreased oral intake and confusion. She was diagnosed with secondary AI and intravenous hydrocortisone was promptly begun. Over the next few days, however, the patient developed severe thirst and polyuria exceeding 6 L of urine per day, accompanied by hypernatraemia and hypo-osmolar urine. She was presumed to have CDI due to NS, and intranasal desmopressin was administered. This eventually normalised her urine output and serum sodium. The patient was discharged improved on intranasal desmopressin and oral prednisone. AI may mask the manifestation of CDI because low serum cortisol impairs renal-free water clearance. Steroid replacement reverses this process and unmasks an underlying CDI.

Topics: Adrenal Insufficiency; Antidiuretic Agents; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Glucocorticoids; Humans; Hydrocortisone; Hypernatremia; Middle Aged; Polyuria; Prednisone; Sarcoidosis; Thirst

Topics: Adult; Anti-Inflammatory Agents; Antidiuretic Agents; Azathioprine; Biopsy; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Drug Therapy, Combination; Humans; Image Enhancement; Immunosuppressive Agents; Lung; Magnetic Resonance Imaging; Male; Pituitary Gland; Prednisolone; Receptors, Interleukin-2; Sarcoidosis; Sarcoidosis, Pulmonary; Tomography, X-Ray Computed

Central nervous system (CNS) sarcoidosis is a crucial disease and has a poor prognosis. A 58-year-old woman had acute development of polydipsia and polyuria. Her pituitary MRI demonstrated a swelling of pituitary gland and hypophyseal stalk. She was diagnosed as central diabetes insipidus (CDI) due to CNS sarcoidosis based on the examinations and pituitary MRI findings as well as a result of cutaneous biopsy. Uveitis and bilateral hilar lymphadenopathy were observed mildly throughout. However, CDI and pituitary MRI findings were getting recovered spontaneously without steroid treatment in a couple of months, suggesting an atypical clinical course of CNS sarcoidosis.

Topics: Antidiuretic Agents; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Middle Aged; Remission, Spontaneous; Sarcoidosis

To report a case of neurosarcoidosis with rapid progression of visual field defects.. A 28-year-old woman presented with bilateral uveitis and was diagnosed as having sarcoidosis after skin and cervical lymph node biopsy. Since bilateral excavations of the optic nerve head and visual field defects were observed, endocranial lesion was suspected. However, a computed tomography (CT) scan of the head detected nothing abnormal. It was regarded as a case of sarcoidosisaccompanied by normal-tension glaucoma and treatment was initiated with latanoprost. Four months later, the patient's visual field deteriorated rapidly. A CT scan showed a pituitary mass. Neurologicalfindings and hypopituitarism were found which improved with systemic prednisolone therapy. Diabetes insipidus developed after the start of treatment, and was treated with intranasal desmopressin therapy. After 6 weeks, head magnetic resonance imaging (MRI) showed a remarkable reduction of the enhanced regions.. Although ocular sarcoidosis is often accompanied by secondary glaucoma or optic nerve atrophy, the progression of neurosarcoidosis can lead to visual field defects. Central nervous system (CNS) sarcoidosis is rare, but a precise examination with enhanced MRI should be considered when the visual field defect progresses rapidly.

Topics: Adult; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Prednisolone; Sarcoidosis; Tomography, X-Ray Computed; Treatment Outcome; Uveitis; Vision Disorders; Visual Fields