Diabetes insipidus as a first manifestation in multiple sclerosis
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Endocrine disturbance in multiple sclerosis (MS) is a rare condition and involvement of the hypothalamus is rarely described.1 The hypothalamus encompasses many nuclei where demyelinating lesions are hardly detectable using conventional MRI.2
Deficiency of antidiuretic hormone (ADH) can be encountered in inflammatory processes such as sarcoidosis, but may be idiopathic, possibly related to pathogenic antibodies. In MS, only 2 cases of ADH deficiency have been reported without overt hypothalamic lesions.3,4 Herein, we present the case of a 28-year-old man who developed diabetes insipidus (DI) 7 years before diagnosis of MS. MRI revealed the presence of bilateral MS lesions in the supraoptic nuclei, suggesting that DI was the first manifestation of MS.
Case report.
A 28-year-old man was referred after discovering cerebral white matter abnormalities on an MRI prescribed to explore DI. The patient had ingested >10 L of water every day since the age of 21. He had neither familial history of DI nor personal antecedent head trauma or neurosurgery.
Neurologic and general examinations were normal. The patient had no history of asthenia, fever, dyspnea, coughs, arthritis, parotitis, …
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