Abstract
Background. A 42-year-old woman presented to the neuroendocrine unit of a hospital with recent-onset polydipsia, polyuria and oligomenorrhea. She had no visual symptoms, head injury or history of malignancy.
Investigations. Measurement of serum sodium and osmolality (as well as urine osmolality) after water deprivation, both before and after desmopressin administration. Measurement of basal serum concentrations of pituitary hormones, insulin-like growth factor 1 and thyroid hormone, cosyntropin stimulation testing of adrenal function, and growth-hormone-releasing hormone–arginine stimulation testing. MRI of the pituitary, CT of the chest and abdomen, skeletal surveys, analyses of cerebrospinal fluid, serology and histologic examination of an excised, painful submandibular salivary gland.
Diagnosis. Central diabetes insipidus and anterior hypopituitarism secondary to Langerhans cell histiocytosis.
Management. Replacement therapies, including desmopressin, levothyroxine, cyclic estrogen with medroxyprogesterone, and growth hormone. The stalk lesion remained stable after 7 years without specific therapy.
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Change history
25 November 2010
In the version of this article initially published online, there was an omission in the Acknowledgments section. The first sentence of this section should have read: Written consent for publication was obtained from the patient. The error has been corrected in all electronic versions of the text.
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Written consent for publication was obtained from the patient. L. Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
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Tritos, N., Byrne, T., Wu, CL. et al. A patient with diabetes insipidus, anterior hypopituitarism and pituitary stalk thickening. Nat Rev Endocrinol 7, 54–59 (2011). https://doi.org/10.1038/nrendo.2010.198
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DOI: https://doi.org/10.1038/nrendo.2010.198