deamino-arginine-vasopressin and Sarcoidosis--Pulmonary

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

In 2003, a 64-year-old woman was diagnosed with mixed connective tissue disease and treated with oral prednisolone (30 mg/day). The prednisolone dose was gradually decreased, and a dose of 5 mg/day had been maintained since 2004. In 2009, she gradually developed vision loss, malaise, anorexia, and throat pain due to hydrodipsia. She was noted to have iritis and vitreous opacity by an ophthalmologist, and was referred for further evaluation. Fine rales were audible throughout the entire lung field, and chest CT showed diffuse small nodules that were more prominent on the upper and middle lobes, and swelling of the mediastinal and hilar lymph nodes. Transbronchial lung biopsy showed many epithelioid granulomas with multinuclear giant cells, compatible with sarcoidosis. Polyuria was identified as a cause of hydrodipsia and a diagnosis of partial central diabetes insipidus was made. High-dose prednisolone (40 mg/day) together with intranasal administration of desmopressin resulted in improvement of all of her clinical symptoms. MCTD followed by sarcoidosis is rare. Furthermore, this is the first reported case of MCTD complicated by sarcoidosis and central diabetes insipidus.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Humans; Middle Aged; Mixed Connective Tissue Disease; Prednisolone; Sarcoidosis, Pulmonary; Treatment Outcome

We here report a 77-year-old Japanese male who suffered general fatigue with progressive thirst and polyuria. Central diabetes insipidus was diagnosed by depletion of vasopressin secretion in response to increases in serum osmolality. Secretory responses of anterior pituitary hormones including adrenocorticotropin, thyrotropin, gonadotropins and growth hormone were severely impaired. Diffuse swelling of the infundibulum as well as lack of T1-hyperintense signal in the posterior lobe was noted by pituitary magnetic resonance imaging. The presence of bilateral hilar lymphadenopathy and increased CD4/CD8 ratio in bronchoalveolar lavage fluid was diagnostic for lung sarcoidosis. Physiological doses of corticosteroid and thyroid hormone were administered in addition to desmopressin supplementation. Complete regression of the neurohypophysial swelling was notable two years after corticosteroid replacement. Diffuse damage of anterior pituitary combined with hypothalamic involvement leading to central diabetes insipidus is a rare manifestation in such elderly patients with neurosarcoidosis.

Topics: Aged; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Hormone Replacement Therapy; Humans; Hydrocortisone; Hypopituitarism; Male; Sarcoidosis, Pulmonary; Thyroxine