Adipsic central diabetes insipidus as a result of neurosarcoidosis

Radmila Milosheska, Department of Endocrinology, Diabetes and Metabolic Diseases, City General Hospital 8th September, Skopje, North Macedonia
Ivana Mickovski, Department of Endocrinology, Diabetes and Metabolic Diseases, City General Hospital 8th September, Skopje; Medical Sciences Faculty, Goce Delcev University, Stip; North Macedonia
Daniela Buklioska Ilijevska, Department of Endocrinology, Diabetes and Metabolic Diseases, City General Hospital 8th September, Skopje; Department of Pulmonology and Allergology, City General Hospital 8th September, Skopje. North Macedonia

Sarcoidosis is a systemic multisystem inflammatory disorder of unknown etiology characterized by the presence of non-caseating granulomas. Neurosarcoidosis leads to hypothalamus- pituitary axis dysfunction, and the most common clinical manifestation is the onset of arginine vasopressin deficiency. We present a case involving a 46-year-old female patient with neurosarcoidosis and associated changes in the hypothalamus-pituitary axis, leading to clinical manifestations of hypopituitarism and an atypical presentation of arginine vasopressin deficiency. The diagnosis of neurosarcoidosis has not been confirmed throughthrough biopsy due to its associated high risk and accessibility challenges. However, based on the computed tomography and magnetic resonance imagingcomputed tomography and magnetic resonance imagingresults and the clinical presentation, the patient received hormone replacement therapy with levothyroxine 25 mcg, hydrocortisone 20 mg + 10 mg, and desmopressin 50 mcg to alleviate the clinical symptoms. Notably, the diagnosis of arginine vasopressin deficiency could not be confirmed based solely on clinical characteristics due to the absence of polydipsia and polyuria. In addition, the classic water deprivation test was inconclusive due to persistent hypernatremia, which was confirmed by ruling out other potential causes of hypernatremia. Neurosarcoidosis presents a diverse clinical profile and poses challenges in diagnosis and treatment, particularly in patients with disorders affecting the hypothalamus-pituitary axis and non-typical arginine vasopressin deficiency. 

Keywords: Neurosarcoidosis. Arginine vasopressin deficiency. Hypernatremia.