Endocrine Abstracts

Background: Sarcoidosis is an immune-mediated condition characterized by the presence of non-caseating granulomas, primarily impacting the respiratory system, lymphatic system and heart. The involvement of the central nervous system, especially hypothalamic- pituitary involvement is a rare occurrence. We report a patient initially presenting with Cranial Diabetes Insipidus who was later diagnosed to have sarcoidosis.

Case presentation: A-67-year old male presented with progressive polydipsia, polyuria and nocturia for 7 months duration without any other systemic symptoms. He had no headaches or constitutional symptoms such as poor appetite, weight loss or night sweats. His physical examination had been unremarkable. He was noted to have a high serum osmolality of 307 mmol/kg and a relatively dilute urine osmolality of 143 mmol/kg. His serum co-peptin after an overnight fast came back relatively low at 1.9 pmol/l in the presence of a serum sodium of 148 mmol/l suggestive of Cranial Diabetes Insipidus. The rest of the pituitary hormones were within the normal range and the MRI pituitary showed thickening and enlargement of the pituitary stalk with absent posterior pituitary bright spot. The anterior pituitary appeared normal in size, signal intensity and enhancement pattern. He was successfully treated with Oral Desmopressin 50 mg in the morning and 100 mg at night which completely resolved his symptoms. Fifteen months after developing the initial symptoms of cranial diabetes insipidus, he presented with general lethargy, weight loss, chronic cough and multiple large joint pains. Further investigations revealed a marginally raised ACE level (74 U/l) and CT chest showed irregular septal thickening in left upper and lower lobe, scarring in left apex, multiple mediastinal and hilar nodes, suggestive of sarcoidosis with central nervous system involvement.

Conclusions: The occurrence of central nervous system manifestations in sarcoidosis is rare and individuals might display these symptoms without accompanying systemic manifestations. Recognizing this unusual presentation holds significance in guiding investigations and initiating early treatment to prevent the disease from advancing further.