Central diabetes insipidus unveiled by glucocorticoid therapy in a patient with an empty sella: A case report and literature review.

Abstract

Rationale:Some diseases contribute to hypopituitarism without clinical manifestations and the glucocorticoid therapy may unveil central diabetes insipidus. The condition is rare and usually causes problems for clinical physicians.Patient concerns:A 59-year-old woman presented to our hospital due to facial numbness and persistent eyelid heaviness.Diagnosis:Physical examination and cerebrospinal fluid examination supported a diagnosis of Guillain–Barré syndrome. Magnetic resonance imaging showed an empty sella. Hormone test indicated hypopituitarism.Interventions:The patient received intravenous immunoglobulin and glucocorticoid. Central diabetes insipidus appeared after 20 days. Subsequently, the patient was prescribed 1-desamino-8-D-arginine vasopressin and prednisone.Outcomes:During 6 months’ follow-up, the patient's urine output was gradually reduced to normal level.Lessons:This case indicated that hypopituitarism may be caused by an empty sella and be masked by adrenal insufficiency. Central diabetes insipidus may present after glucocorticoid therapy.