繰り返す細菌性髄膜炎を契機に低Na血症をきたし, 不顕性尿崩症を伴った下垂体膿瘍の一例

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  • A Case of Pituitary Abscess with Masked Diabetes Insipidus following Bacterial Meningitis

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A 37-year-old woman was admitted to our institution because of bacterial meningitis with hyponatremia (121mEq/L). Brain magnetic resonance imaging disclosed a cystic mass extending from the intra sellar to suprasellar regions in a T1 weighted image. Basal plasma levels of LH, FSH, ACTH and cortisol were lower than normal range. The plasma levels of ACTH and cortisol were relatively low during the insulin-stress test. During the intravenous administration of LH-RH and CRH, while ACTH and cortisol increased within the normal range, those of LH and FSH did not. Treatment with hydrocortisone produced a rapid normalization of the serum levels of sodium. However, this treatment led to polyuria with hyposthenuria. Saline (5%) infusion and water loading tests were carried out with or without the administration of oral hydrocortisone (60mg/day). The plasma ADH did not decrease during the water loading test without hydrocortisone, whereas the urinary osmolality value was higher than that observed in the serum. On the other hand, during the saline (5%) infusion test with hydrocortisone, the plasma level of ADH did not increase, and the urinary osmolality value was lower than that observed in the serum. Based on the clinical and histological findings, the diagnosis of pituitary abscess associated with partial hypopituitarism and masked diabetes insipidus were done. From the results of the insulin-stress and CRH tests, the coexistence of hypothalamic dysfunction was also suspected. This is a rare and interesting case of hypopituitarism with masked diabetes insipidus resulting probably from bacterial meningitis and pituitary abscess.

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