Loading...
Publication
Diabetes insípida… um indício para o diagnóstico de sarcoidose
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.32 MB | Adobe PDF |
Advisor(s)
Abstract(s)
O atingimento do sistema nervoso central pela sarcoidose é uma entidade rara, presente em cerca de 5%
dos casos. A diabetes insípida, o hipogonadismo e a hiperprolactinemia são as manifestac¸ ões endócrinas
mais comuns. Apresenta-se o caso de um doente do sexo masculino, caucasiano, 40 anos de idade, com quadro clínico com evoluc¸ ão de 6 meses caracterizado por sede excessiva e preferência por bebidas frias, com polidip sia (5-6 litros de água por dia) e poliúria (5-6 litros por dia). Como antecedentes relevantes a realc¸ ar nefrolitíase. Foi pedida uma ressonância magnética da hipófise que revelou: «ausência de hipersinal da
hipófise posterior na ponderac¸ ão T1 e alargamento da haste hipofisária». O doente foi então orientado à
consulta de endocrinologia, tendo ficado internado para efetuar prova de restric¸ ão hídrica. Confirmou-se
diabetes insípida central com défice parcial de arginina-vasopressina (AVP), de etiologia a esclarecer. Os
outros doseamentos hormonais estavam normais. Analiticamente apresentava hipercalcemia e elevac¸ ão
da enzima conversora da angiotensina, pelo que no internamento se pediu uma telerradiografia de tórax
que mostrou adenopatia hilar bilateral e infiltrado reticulo-intersticial difuso. Perante a suspeita clínica
de sarcoidose, foram efetuados cintigrafia com gálio67, lavado broncoalveolar e biópsia transbrônquica,
com confirmac¸ ão deste diagnóstico. O doente foi medicado com desmopressina intranasal (20 /dia) e
prednisolona oral (40 mg/dia), atualmente com remissão dos sintomas. Os autores pretendem realc¸ ar a diabetes insípida como manifestação inicial que levou ao diagnóstico de sarcoidose, até então desconhecida neste doente. É feita uma breve revisão da literatura no âmbito destas patologias.
Central Nervous System involvement by sarcoidosis is a rare condition, present in only about 5% of cases. Diabetes insipidus, hypogonadism and hyperprolactinemia are the most common endocrine manifestations. A 40‐year‐old caucasian male presented with a 6‐month history of progressive thirst and preference for cold water, polydipsia (5‐6 liters/day of fluids) and polyuria (5‐6 liters/day). He had a personal history of nephrolithiasis. He was ordered a pituitary magnetic ressonance image (MRI) which shown “an enlarged infundibular stalk and absence of the posterior pituitary bright spot on T1 – weighted images”. He was then referred to Endocrinology Department, where he performed a water restriction He was then referred to Endocrinology Department, where he performed a water restric tion test. Central diabetes insipidus was confirmed, with partial deficit of arginine-vasopressine (AVP), of unknown etiology. The other hormone levels were normal. In the blood analysis it was noticed hypercalcemia and elevation of angiotensine converting enzyme (ECA), so the patient was ordered a chest x-ray which shown bilateral enlargement of hilar lymph nodes and pulmonary infiltrates
Central Nervous System involvement by sarcoidosis is a rare condition, present in only about 5% of cases. Diabetes insipidus, hypogonadism and hyperprolactinemia are the most common endocrine manifestations. A 40‐year‐old caucasian male presented with a 6‐month history of progressive thirst and preference for cold water, polydipsia (5‐6 liters/day of fluids) and polyuria (5‐6 liters/day). He had a personal history of nephrolithiasis. He was ordered a pituitary magnetic ressonance image (MRI) which shown “an enlarged infundibular stalk and absence of the posterior pituitary bright spot on T1 – weighted images”. He was then referred to Endocrinology Department, where he performed a water restriction He was then referred to Endocrinology Department, where he performed a water restric tion test. Central diabetes insipidus was confirmed, with partial deficit of arginine-vasopressine (AVP), of unknown etiology. The other hormone levels were normal. In the blood analysis it was noticed hypercalcemia and elevation of angiotensine converting enzyme (ECA), so the patient was ordered a chest x-ray which shown bilateral enlargement of hilar lymph nodes and pulmonary infiltrates
Description
Keywords
Diabetes Insipidus sarcoidose Região Autónoma da Madeira Portugal Madeira Island
Citation
Rev Port Endocrinol Diabetes Metab. 2014;9(2):144–148
Publisher
ElsevierEspaña, S.L.U.