Endocrine Abstracts

Introduction: Acute myeloid leukemia infiltrates the CNS in up to 50% of cases. In contrast, the infiltration of the pituitary gland by leukemia cells is unusual. To date, AML presenting with central diabetes insipidus (CDI) has been rarely reported. Here, we present a patient with AML (subtype clasification is proceeding) presenting with panhypopituitarism and CDI.

Case report: A 37-years-old man, with no significant past medical history, presented to Emergency department with complaint of high fever. Laboratory tests revealed increased CRP, ESR, serum sodium was 157 mEq/l and free cortizol was 3 μg/dl. Patient diagnosed as panhypopituitarism according to the pituitary hormones values (TSH:0.04 μIU/ml (0.2–4.2), ft₄: 0.801 ng/dl (0.99–1.65), kortizol: 3.21 μg/dl, ACTH: 12.3 pg/ml). On the mri scan, FLAIR image shows hyperintense lesions in bilateral hypothalamic areas probable due to leukemic infiltration and mri spectroscopy reveals high cho/cr and cho/naa ratios. Patient admitted the endocrinology clinic and hyponatremic IV hydration (%0.45 saline and %5 dextroz) was given in order. After correction of hypernatremia and dehydration, water deprivation test showed worsening of hypernatremia (sodium: 156 mEq/l), and serum osmolality test showed hyperosmolality (320 mosm/kg) with inappropriate low urine osmolality (170 mOsm/kg). Patient was treated with prednizolon, desmopression and levoT₄ sodium for panhypopituitarism. On the third day of admission, The laboratory studies showed neutropenia (white blood cell 2.6 k/μl), macrocytic anaemia (Hemoglobin 10.2 μg/dl, MCV 131.7 fl),and mild thrombocytosis. A diagnosis of myeloid leukemia was confirmed after examination of a peripheral blood and bone marrow aspiration (the genetic analysis is proceeding).

Conclusion: In conclusion, this is the first case of reporting coexistance of AML, CDI, panhypopituitarism and hypothalamic lesions probable due to leukemic infiltration.