Central diabetes insipidus: beware of Langerhans cell histiocytosis!

Neth J Med. 2018 Dec;76(10):445-449.

Abstract

Langerhans cell histiocytosis (LCH) is a rare disorder, characterised by a monoclonal proliferation of aberrant histiocytes that accumulate in and infiltrate into different organs. When the hypothalamic-pituitary axis is involved, central diabetes insipidus (CDI) can be its first manifestation. Three cases of LCH with central diabetes insipidus were retrospectively analyzed: Case 1 is a 41-year old female presenting with polyuria and polydipsia. Diabetes insipidus was diagnosed and treated with desmopressin. MRI pituitary showed hypophysitis. Subsequently, she developed bone lesions and a biopsy demonstrated LCH. Case 2 is a 51-year old female presenting in 2009 with polyuria and polydipsia. Diabetes insipidus was diagnosed and treated with desmopressin. MRI pituitary revealed hypophysitis. LCH was suspected because of known pulmonary histiocytosis. Coexisting bone lesions were biopsied and confirmed LCH. Case 3 is a 44-year old female presenting with diabetes insipidus. She was treated with desmopressin as well. MRI of the pituitary gland showed impressive thickening of the infundibulum. A few months later, she developed skin lesions and a biopsy revealed LCH. Conclusively, LCH is a rare, elusive and probably underdiagnosed disease with a broad disease spectrum. Due to infiltration of the hypothalamic-pituitary axis, CDI can be the first manifestation, even before LCH is diagnosed. Therefore, LCH should be considered in the diagnostic workup of CDI.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antidiuretic Agents / administration & dosage
  • Biopsy / methods
  • Bone Diseases* / diagnostic imaging
  • Bone Diseases* / etiology
  • Bone Diseases* / pathology
  • Deamino Arginine Vasopressin / administration & dosage*
  • Diabetes Insipidus, Neurogenic* / diagnosis
  • Diabetes Insipidus, Neurogenic* / drug therapy
  • Diabetes Insipidus, Neurogenic* / etiology
  • Diagnosis, Differential
  • Female
  • Histiocytosis, Langerhans-Cell* / diagnosis
  • Histiocytosis, Langerhans-Cell* / physiopathology
  • Histiocytosis, Langerhans-Cell* / therapy
  • Humans
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Pituitary Diseases / diagnosis
  • Pituitary Diseases / etiology
  • Pituitary Gland* / diagnostic imaging
  • Pituitary Gland* / pathology
  • Skin Diseases* / diagnostic imaging
  • Skin Diseases* / etiology
  • Skin Diseases* / pathology

Substances

  • Antidiuretic Agents
  • Deamino Arginine Vasopressin