Case contributed by Luis Felipe Camarillo
Diagnosis almost certain


Presented 4-month gradual onset of polyuria, polydipsia and high urinary volume referred more than 6 liters per day.

Patient Data

Age: 35 years
Gender: Male

Non-contrast sagittal T1-weighted image showing absence of the habitual hyperintensity of the posterior pituitary and bulky infundibulum of 5.3 mm. Sagittal T1-weighted imagen with contrast (Gadolinium) showing normal enhancement of the anterior pituitary and vivid enhancement of the bulky infundibulum, measuring 5.3 mm.

Coronal sequences of the pituitary fossa. Non-contrast T1-weighted image showing a bulky infundibulum and T1-weighted postcontrast with a vivid enhancement of the bulky infundibulum, measuring 5.3 mm.

Case Discussion

Infundibuloneurohypophysitis is a rare disorder that may present with the acute onset of central diabetes insipidus.

In this case, a 35-year-old male with acute onset of symptoms (polyuria, polydipsia, and high urinary volume output) was presented. Physical examination, serum osmolality and serum sodium were normal, in the presence of very diluted and hypotonic urine. The water deprivation test confirmed the diagnosis of diabetes insipidus.

MRI shows a normal anterior hypophysis with a lack of high signal in T1 of the neurohypophysis and a bulky infundibulum of 5.3 mm with vivid enhancement after contrast use.

The patient was treated with glucocorticoids and desmopressin with total regression of symptoms and radiological findings in 7 months.

The clinical suspicion is high in this patient, however, a definitive diagnosis can only be established by histopathologic findings. Other differential diagnosis was considered such as sarcoidosis, germinoma, histiocytosis but were discounted by laboratory findings, and they rarely regress and may even progress rapidly in most cases. 

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