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-ca
seating granulomas. Neurosarcoidosis leads to hypothala
mus-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 neuro
sarcoidosis and associated changes in the hypothalamus-pitu
itary 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 acces
sibility 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 levothy
roxine 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 polydip
sia 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 defi
ciency. Hypernatremia.