Diabetes insipidus as a rare cause of acute cognitive impairment in multiple sclerosis

Multiple sclerosis (MS) is a complex neurodegenerative disease presenting with a diversity of clinical symptoms including palsy and cognitive impairment. We present a 59-year-old woman with a history of secondary progressive MS since 1987, who was referred to our department because of recent onset o...

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Bibliographic Details
Published in:Multiple sclerosis 2013-10, Vol.19 (12), p.1676-1678
Main Authors: Tiedje, V, Schlamann, M, Führer, D, Moeller, LC
Format: Article
Language:English
Subjects:
Atrophy
Biological and medical sciences
Cognition Disorders - etiology
Confusion - etiology
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Diabetes Insipidus - complications
Diabetes Insipidus - psychology
Endocrinopathies
Female
Humans
Hyponatremia - etiology
Hypothalamus - pathology
Hypothalamus. Hypophysis. Epiphysis (diseases)
Immunomodulators
Magnetic Resonance Imaging
Medical sciences
Middle Aged
Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis
Multiple Sclerosis, Chronic Progressive - complications
Multiple Sclerosis, Chronic Progressive - psychology
Neurology
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Pharmacology. Drug treatments
Polydipsia - etiology
Sodium - blood
Vasopressins - metabolism
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Summary:Multiple sclerosis (MS) is a complex neurodegenerative disease presenting with a diversity of clinical symptoms including palsy and cognitive impairment. We present a 59-year-old woman with a history of secondary progressive MS since 1987, who was referred to our department because of recent onset of confusion and polydipsia. Initial lab tests showed mildly elevated serum sodium levels and low urine osmolality. Under water deprivation, diuresis and low urine osmolality persisted and serum sodium levels rose above 150 mmol/l. Oral desmopressin resulted in normalisation of serum sodium as well as urine osmolarity, confirming a diagnosis of central diabetes insipidus. As drug-induced diabetes could be excluded, pituitary magnetic resonance imaging (MRI) was performed. A demyelinating lesion was detected in the hypothalamus. The patient was started on oral desmopressin treatment (0.2 mg/day). Fluid intake and serum sodium levels have since remained normal. In summary, we report the rare case of a patient presenting with diabetes insipidus due to progressive MS. Diabetes insipidus should be considered in MS patients who develop new onset of polydipsia.
ISSN:1352-4585
1477-0970
DOI:10.1177/1352458513506952