Diabetes insipidus on MRI

Case contributed by Dr Gaurav Som Prakash Gupta

Presentation

Diabetes inspidus.

Patient Data

Age: 40
Gender: Male
Modality: MRI

This contrast enhanced dynamic MR shows an absent posterior pituitary bright spot on the pre-enhanced T1WI.

The MR also shows a thick (3.8 mm, normal is < 2.4 mm), but normally enhancing pituitary stalk. 

In absence of any other biochemical finding or significant clinical history- one would consider autoimmune disorder as the likely cause.

Case Discussion

There are several causes of central diabetes insipidus (DI). MR is done to try and find out the cause of central DI.  The presence of a thickened pituitary stalk in this case points towards possibility of either inflammatory or autoimmune hypophysitis. When the inflammation is limited to the posterior pituitary the condition may be termed as infudibuloneurohypophysitis. If the anterior pituitary is also involved (not seen in this case) the condition may be termed as infundibuloihypophysitis (dropping the term "neuro"). Such kind of global involvement of the pituitary is seen in lymphocytic hypophysitis,

Although final cause of the pituitary stalk inflammation could not be established in this case, however, the MR images serves to demonstrate the prudent approach to a patient with DI (central DI).

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Case Information

rID: 24225
Case created: 1st Aug 2013
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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