Adipsic central diabetes insipidus as a result of neurosarcoidosis

Sarcoidosis is a systemic multisystem inflammatory disorder
of unknown etiology characterized by the presence of non-caseating granulomas. Neurosarcoidosis leads to hypothalamus-pituitary axis dysfunction, and the most common clinical manifestation is the onset of arginine vasopressin deficiency. We present a case involving a 46-year-old female patient with neurosarcoidosis and associated changes in the hypothalamus-pituitary axis, leading to clinical manifestations of hypopituitarism and an atypical presentation of arginine vasopressin deficiency.
The diagnosis of neurosarcoidosis has not been confirmed
throughthrough biopsy due to its associated high risk and accessibility challenges. However, based on the computed tomography and magnetic resonance imagingcomputed tomography and magnetic resonance imagingresults and the clinical presentation, the patient received hormone replacement therapy with levothyroxine 25 mcg, hydrocortisone 20 mg + 10 mg, and desmopressin 50 mcg to alleviate the clinical symptoms. Notably, the diagnosis of arginine vasopressin deficiency could not be confirmed based solely on clinical characteristics due to the absence of polydipsia and polyuria. In addition, the classic water deprivation test
was inconclusive due to persistent hypernatremia, which was
confirmed by ruling out other potential causes of hypernatremia. Neurosarcoidosis presents a diverse clinical profile and poses challenges in diagnosis and treatment, particularly in patients with disorders affecting the hypothalamus-pituitary axis and non-typical arginine vasopressin deficiency.
Keywords: Neurosarcoidosis. Arginine vasopressin deficiency. Hypernatremia.