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International Journal of Advances In Case Reports

Volume 11, Issue 1, 2024
Mcmed International
International Journal of Advances In Case Reports
Issn
XXX-XXXX (Print), 2349 - 8005 (Online)
Frequency
bi-annual
Email
editorijacr@mcmed.us
Journal Home page
http://mcmed.us/about/ijacr
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Abstract
Title
CENTRAL DIABETES INSIPIDUS CAUSED BY A PITUITARY ADENOMA, MASQUERADING AS BENIGN PROSTATE HYPERPLASIA IN A NATIVE HAWAIIAN
Author
Timothy A. Gregory, Rodger Stitt*, Robert Greenwood, Arthur F. Guerrero
Email
rodger.s.stitt.mil@mail.mil
keyword
Diabetes insipidus, Pituitary macroadenoma, Pituitary adenoma, Hypovolemic shock.
Abstract
Objective an aggressively infiltrative pituitary lesion might suggest an inflammatory or granulomatous condition such as lymphocytic hypophysitis or neurosarcoidosis; however, here we demonstrate that though rare, it is possible for pituitary adenoma invasion to sufficiently interrupt secretion of AVP and cause diabetes insipidus. We report on a native Hawaiian patient who presented critically after months of polyuria and nocturia that had been attributed to benign prostatic hyperplasia and treated with finasteride. He had become accustomed to ignoring his thirst drive due to social pressures in his workplace where he was teased for drinking copious amounts of water and taking frequent bathroom breaks. As a result, he eventually presented in hypovolemic shock with tachycardia and hypernatremia. After stabilization, the patient was found to have an infiltrative sellar mass that did not respond to corticosteroids. Transsphenoidal excision yielded tissue consistent with infarcted non-functioning pituitary adenoma. His pituitary function did not recover, but after receiving coaching to properly respond to his thirst, the patient has remained stable on intranasal desmopressin. An intact thirst drive and access to water are essential backup mechanisms to combat the life-threatening hypernatremia caused by diabetes insipidus. This case illustrates the importance of social history for clarifying etiology as well as managing an unusual manifestation of pituitary macroadenoma.
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