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Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report

BACKGROUND: Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. CASE PRESENTATION: A 68-year-old Japanese female s...

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Autores principales: Hashimoto, Hiroaki, Maruo, Tomoyuki, Nakamura, Masami, Ushio, Yukitaka, Hirata, Masayuki, Kishima, Haruhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759158/
https://www.ncbi.nlm.nih.gov/pubmed/35027091
http://dx.doi.org/10.1186/s13256-021-03229-y
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author Hashimoto, Hiroaki
Maruo, Tomoyuki
Nakamura, Masami
Ushio, Yukitaka
Hirata, Masayuki
Kishima, Haruhiko
author_facet Hashimoto, Hiroaki
Maruo, Tomoyuki
Nakamura, Masami
Ushio, Yukitaka
Hirata, Masayuki
Kishima, Haruhiko
author_sort Hashimoto, Hiroaki
collection PubMed
description BACKGROUND: Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. CASE PRESENTATION: A 68-year-old Japanese female suffering from pituitary and thalamic metastases caused by untreated breast cancer, underwent a biopsy targeting the thalamus, not the pituitary. She lacked prebiopsy pituitary dysfunction symptoms; however, these symptoms unexpectedly occurred after biopsy. Diabetes insipidus was masked by corticosteroid insufficiency, and she showed normal urinary output and plasma sodium levels. Upon commencement of glucocorticoid replacement therapy, the symptoms of diabetes insipidus appeared. CONCLUSIONS: In this case, thalamic biopsy, as opposed to pituitary biopsy, was performed to preserve pituitary function. However, pituitary dysfunction could not be avoided. Caution is necessary for asymptomatic patients with pituitary metastases as invasive interventions, such as surgery, may induce pituitary dysfunction. Moreover, with respect to masked diabetes insipidus, there is a need to carefully consider pituitary dysfunction to avoid misdiagnosis and delayed treatment.
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spelling pubmed-87591582022-01-18 Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report Hashimoto, Hiroaki Maruo, Tomoyuki Nakamura, Masami Ushio, Yukitaka Hirata, Masayuki Kishima, Haruhiko J Med Case Rep Case Report BACKGROUND: Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. CASE PRESENTATION: A 68-year-old Japanese female suffering from pituitary and thalamic metastases caused by untreated breast cancer, underwent a biopsy targeting the thalamus, not the pituitary. She lacked prebiopsy pituitary dysfunction symptoms; however, these symptoms unexpectedly occurred after biopsy. Diabetes insipidus was masked by corticosteroid insufficiency, and she showed normal urinary output and plasma sodium levels. Upon commencement of glucocorticoid replacement therapy, the symptoms of diabetes insipidus appeared. CONCLUSIONS: In this case, thalamic biopsy, as opposed to pituitary biopsy, was performed to preserve pituitary function. However, pituitary dysfunction could not be avoided. Caution is necessary for asymptomatic patients with pituitary metastases as invasive interventions, such as surgery, may induce pituitary dysfunction. Moreover, with respect to masked diabetes insipidus, there is a need to carefully consider pituitary dysfunction to avoid misdiagnosis and delayed treatment. BioMed Central 2022-01-14 /pmc/articles/PMC8759158/ /pubmed/35027091 http://dx.doi.org/10.1186/s13256-021-03229-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Hashimoto, Hiroaki
Maruo, Tomoyuki
Nakamura, Masami
Ushio, Yukitaka
Hirata, Masayuki
Kishima, Haruhiko
Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
title Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
title_full Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
title_fullStr Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
title_full_unstemmed Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
title_short Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
title_sort masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759158/
https://www.ncbi.nlm.nih.gov/pubmed/35027091
http://dx.doi.org/10.1186/s13256-021-03229-y
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