Central Diabetes Insipidus: An Unusual Presentation of Hodgkin`s

Central Diabetes Insipidus: An Unusual Presentation of Hodgkin’s Lymphoma
Arinzechukwu Uzoechina MD*, Siddhartha Kattamanchi MD*; Ram Pathak MD†
Departments of Medicine* and Endocrinology†, Marshfield Clinic, Marshfield, WI
Introduction
Case Description
Central diabetes insipidus is associated with lung
cancer, leukemia and non-hodgkin’s lymphoma.
We present an unusual case of Hodgkin’s
lymphoma presenting as central diabetes
insipidus (CDI).
Water deprivation test revealed maximum serum
and urine osmolalities of 306mOsm/L and
361mOsm/L respectively. Post DDAVP,
maximum urine osmolality was 685mosm/L.
Metastatic hodgkin’s lymphoma (confirmed by
lymph node biopsy) was thought to be the most
probable cause .
Discussion
Post-treatment images
(figures 2A & 2B) showed
reduction in size of the pituitary and the
infundibulum.
Case Description
A 25yr old male presented to the hospital with a
one month history of polyuria, polydipsia and
nocturia. He had a significant history of weight
loss and no history of diabetes mellitus, seizures,
head trauma, neurosurgery, blurring of vision,
lithium therapy. He has a family history of diabetes
mellitus type II. He has no known family history of
diabetes insipidus.
Examination revealed stable vital signs,
absence of pallor, jaundice, volume depletion or
peripheral lymphadenopathy. Lungs were clear on
auscultation. Heart sounds were normal. Abdomen
was nontender and without palpable
organomegaly.
Further evaluation revealed a normal calcium
and fasting blood sugar. Urinalysis was
unremarkable. Chest x-ray revealed a superior
mediastinal mass. CT scan of the chest and
abdomen and showed extensive
lymphadenopathy involving the mediastinum,
axillae and porta hepatis. Bilateral pulmonary
nodules and splenomegaly were noted. Lymph
node biopsy revealed Hodgkin’s lymphoma. PET
scan showed extensive metastasis.
Case Description
Figure 1A . MRI brain T1
FLAIR image.
Figure 2A. MRI brain T1weighted image.
Figure 1B. MRI brain T2
image at presentation
Figure 2B. MRI brain T2weighted image after
treatment
MRI of the brain at presentation (Figures 1A & 1B)
revealed unusual fullness of the posterior pituitary and
neurohypophysis, and absence of posterior pituitary
bright spot.
Discussion
Central diabetes insipidus (CDI) is very
uncommon in the United States.1 Causes include
autoimmune disease, neurosurgery, head trauma,
sarcoidosis, neoplasm.1 Lung cancer, nonHodgkin’s lymphoma and leukemia are
associated with CDI. Central diabetes insipidus
may be the initial presentation of metastatic
disease in some patients. Here we report a rare
case of Hodgkin’s lymphoma presenting as CDI.
Therefore malignancies should be considered in
patients with central diabetes insipidus.
Reference
1. Saborio P, Tipton GA, Chan JC. Diabetes
insipidus. Pediatr Rev. 2000;21(4):122-9; quiz
129.

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