Endocrine Abstracts

Introduction: There are many causes of central diabetes insipidus including trauma, drugs, metastatic tumor, lymphoma, leukemia, inflammation, virus infection and gene mutation. They’re very few cases in England reported as pituitary involvement of NHL [no-Hodgkin lymphoma] Approximately about 31 cases were reported in the literature as NHL of the pituitary as in Pub medicine, however in these series of cases the most common presentation among them was central hypothyroidism followed by adrenal insufficiency and diabetes insipidus subsequently. Learning points • Relapse of NHL presenting as diabetes insipidus is rare presentation and sudden onset of cranial diabetes insipidus in patient with complete remission should raise the suspicious of the relapse. • Although tissue diagnosis is the gold standard for the diagnosis but the images and clinical presentation is acceptable when the tissue diagnosis is not amenable.• As in all other malignance’s the treatment rely on the prognosis and the quality of life.

Case report: 71 years old lady with previous history of non-Hodgkin lymphoma of spine under remission for many years, presented with features of diabetes insipidus. Subsequent investigation confirmed diabetes insipidus. Her blood test didn’t show hypopituitarism however prolactin was elevated because of stalk pressure effect. Treated with close monitoring, IV dextrose 5% and desmopressin subcutaneously 1mg three times /day with aiming of urine output <200 ml/h. After 72 h of treatment her sodium dropped to <150 and her urine output approximately was 150ml/h. On the fifth day her sodium was around 135 and she became more alert and started to eat and drink. MRI pituitary with contrast revealed hypothalamic lesion approximately 9mm highly suspicious of no-Hodgkin lymphoma. She has been discussed in both Neuro-oncology MDT and Hematology MDT and both decided for supportive care given the outcome likely poor and no further step needed.