Breast cancer with diabetes insipidus
Diabetes insipidus (DI) is a rare clinical condition, which is usually caused by neurohypophyseal or pituitary stalk infiltration in cancer patients. Case report: we present a 62-year old metastatic breast cancer woman with DI. She admitted to the hospital because of nausea, vomiting, polyuria and p...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
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| Zitieren: | Breast cancer with diabetes insipidus / M. Dogan, E. Karakilic, I.I. Oz, F. Zorlu, H. Akbulut // Experimental Oncology. — 2008. — Т. 30, № 4. — С. 324–326. — Бібліогр.: 10 назв. — англ. |
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irk-123456789-1399462018-06-22T03:04:37Z Breast cancer with diabetes insipidus Dogan, M. Karakilic, E. Oz, I.I. Zorlu, F. Akbulut, H. Short communications Diabetes insipidus (DI) is a rare clinical condition, which is usually caused by neurohypophyseal or pituitary stalk infiltration in cancer patients. Case report: we present a 62-year old metastatic breast cancer woman with DI. She admitted to the hospital because of nausea, vomiting, polyuria and polydipsia, while she was on no cytotoxic medication. She had no electrolyte imbalance except mild hypernatremia. The CT scan of the brain yielded a suspicious area in pituitary gland. A pituitary stalk metastasis was found on magnetic resonance imaging (MRI) of pituitary. Water deprivation test was compatible with DI. A clinical response to nasal vasopressin was achieved. Conclusions: Cancer patients who have symptoms such as nausea, vomiting, polyuria and polydipsia while they are not on chemotherapy should be evaluated for not only metabolic complications like hypercalcemia but also posterior pituitary or stalk metastasis MRI could be the choice of imaging for pituitary metastasis. Несахарный диабет (DI) — редкое клиническое состояние, вызываемое инфильтрацией нейрогипофизарной ножки или ножки гипофиза у онкологических больных. Описание случая: в исследовании рассмотрен случай выявления DI у 62-летней женщины, у которой был выявлен рак молочной железы с наличием метастазов. Она поступила в больницу с симптомами тошноты, рвоты, полиурии и полидипсии, хотя не проходила курса химиотерапии. У больной не выявлено дисбаланса электролитов, кроме небольшой гипернатриемии. Компьютерная томография мозга показала подозрительную область в мозговом придатке. На магнитно-резонансном изображении выявлен метастаз в ножке гипофиза. Обезвоживание также соответствовало диагнозу DI. Получен клинический ответ на назальный вазопрессин. Выводы: онкологические больные с симптомами тошноты, рвоты, полиурии и полидипсии, не проходящие курса химиотерапии, должны быть обследованы не только на предмет метаболических осложнений, таких как гиперкальциемия, но и на возможное наличие метастазов в ножке и задней части гипофиза с помощью магнитно-резонансного изображения. Ключевые слова: рак, несахарный диабет, метастаз в гипофизе. 2008 Article Breast cancer with diabetes insipidus / M. Dogan, E. Karakilic, I.I. Oz, F. Zorlu, H. Akbulut // Experimental Oncology. — 2008. — Т. 30, № 4. — С. 324–326. — Бібліогр.: 10 назв. — англ. 1812-9269 http://dspace.nbuv.gov.ua/handle/123456789/139946 en Experimental Oncology Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Short communications Short communications Dogan, M. Karakilic, E. Oz, I.I. Zorlu, F. Akbulut, H. Breast cancer with diabetes insipidus Experimental Oncology |
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Diabetes insipidus (DI) is a rare clinical condition, which is usually caused by neurohypophyseal or pituitary stalk infiltration in cancer patients. Case report: we present a 62-year old metastatic breast cancer woman with DI. She admitted to the hospital because of nausea, vomiting, polyuria and polydipsia, while she was on no cytotoxic medication. She had no electrolyte imbalance except mild hypernatremia. The CT scan of the brain yielded a suspicious area in pituitary gland. A pituitary stalk metastasis was found on magnetic resonance imaging (MRI) of pituitary. Water deprivation test was compatible with DI. A clinical response to nasal vasopressin was achieved. Conclusions: Cancer patients who have symptoms such as nausea, vomiting, polyuria and polydipsia while they are not on chemotherapy should be evaluated for not only metabolic complications like hypercalcemia but also posterior pituitary or stalk metastasis MRI could be the choice of imaging for pituitary metastasis. |
| format |
Article |
| author |
Dogan, M. Karakilic, E. Oz, I.I. Zorlu, F. Akbulut, H. |
| author_facet |
Dogan, M. Karakilic, E. Oz, I.I. Zorlu, F. Akbulut, H. |
| author_sort |
Dogan, M. |
| title |
Breast cancer with diabetes insipidus |
| title_short |
Breast cancer with diabetes insipidus |
| title_full |
Breast cancer with diabetes insipidus |
| title_fullStr |
Breast cancer with diabetes insipidus |
| title_full_unstemmed |
Breast cancer with diabetes insipidus |
| title_sort |
breast cancer with diabetes insipidus |
| publisher |
Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
| publishDate |
2008 |
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Short communications |
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http://dspace.nbuv.gov.ua/handle/123456789/139946 |
| citation_txt |
Breast cancer with diabetes insipidus / M. Dogan, E. Karakilic, I.I. Oz, F. Zorlu, H. Akbulut // Experimental Oncology. — 2008. — Т. 30, № 4. — С. 324–326. — Бібліогр.: 10 назв. — англ. |
| series |
Experimental Oncology |
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| first_indexed |
2025-07-10T09:26:24Z |
| last_indexed |
2025-07-10T09:26:24Z |
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1837251524743397376 |
| fulltext |
324 Experimental Oncology 30, 324–326, 2008 (December)
Arginine vasopression (AVP, secreted from hypo-
thalamus, is a multifunctional neurotransmitter that plays
an important role in water homeostasis [1]. Diabetes
insipidus (DI) is a metabolic disorder which is caused
by disturbance in either AVP secretion or function. It is
characterized with large quantities of urine output with
low density (> 50 ml/kg, osmolarity < 300 mosmol/L) [2].
Granulomatous diseases (i. e. tuberculosis, histiocytosis
and neurosarcoidosis), hematological malignancies
(i. e. leukemia and lymphoma) and solid tumors such as
breast cancer may cause primary central DI. Pituitary me-
tastasis in cancer patients is rare, Most of the reported DI is
caused in patients with either lung or breast cancers [3].
A 62-year old metastatic breast cancer woman was
admitted to the hospital with serious nausea, vomiting,
polyuria and polydipsia after 4 months of follow-up period
without any medication. She had a local recurrence of inva-
sive ductal carcinoma after a 17 year of remission period.
The patient had been followed for an additional 9 years
without any local or distant metastasis. Four years ago,
she developed a lobular carcinoma in contra lateral breast,
which was surgically removed. Three years later she had
local and distant metastasis. Distant metastases were in
skeletal system with multiple involvement, and in ovaries.
Later liver and lung metastases have also recurred.
The patient’s vomiting was unrelated with foods and
not projectile. She had no drug history. On examination,
her performance status was 2 (ECOG), and the rest of
the physical examination was normal. Despite vomiting,
the patient had no signs or symptoms of dehydration
vomiting and, no remarkable finding on neurological
and otorhinolaryngologic examination except pres-
byacusia. Laboratory tests on admission were as follows:
creatinine: 1.09 mg/dl (Normal:0.5–0.9 mg/dl), sodium:
144 mmol/L (normal: 136–146 mmmol/L), potassium:
3.45 mmol/L (3.5–5.1 mmol/L), calcium: 9.44 mg/dl
(normal: 8.6–10.2 mg/dl), albumin: 3.5 g/dl (normal: 3.5–
5.2 g/dl), lactate dehydrogenase (LDH): 617 U/L (normal:
240–480 U/L). Upper gastrointestinal endoscopic biopsy
was compatible with activated chronic atrophic gastritis.
The CT scan of the brain (BCT) yielded a suspicious area
in pituatry gland (Fig. 1). On the third day of admission,
serum sodium levels started rising daily (147–154 U/L).
She had polyuria during hypernatremia, but no neurologi-
cal findings. Serum osmolarity was in upper normal limit
[293 mosmol/kg (normal: 275–295 mosmol/kg)]; urine
osmolarity was 122 mosmol/kg (repeated values were
324.78 mosmol/kg and 203.3 mosmol/kg; normal range:
600–850 mosmol/kg)]; urine sodium was 31 mmol/L
(repeated value was 6 mmol/L]; urine density was 1002
(repeated values were 1008 ve 1007). The water depriva-
tion teat was in consistent with DI. She had high basal
serum osmolarity (306 mosmol/kg), low urine osmolarity
(234 mosmol/kg) and density (1006) whereas high serum
osmolarity (303 ve 310 mosmol/kg), and both low urine
osmolarity (263 ve 321 mosmol/kg) and density (1009 ve
1011) at second-hour and later on water deprivation test.
On MR imaging of the brain, a 13 x 10 mm lesion including
cystic component on posterior part of stalk, which was
considered as metastasis on was noticed (Fig. 2, a, b).
Prolactin level was high [76.57 ng/ml; normal: 6–30 ng/ml]
whereas both insulin like growth factor-1 (IGF-1) and was
growth hormone (GH) levels were low [69.4 ng/ml for
IGF-1; normal range: 94–269 ng/ml and 0.01 ng/mL for
GH; normal range: 0.09–3.83]. She was given Arginin/Va-
sopressin (AVP) nasal spray, 20 mcg bid / day and applied
‘cyber-knife’ (total 1500 cGy) for stalk metastasis. The
symptoms of polyuria, nausea and vomitting decreased
on the third day of the treatment, and hypernatremia
recovered on the fourth day. Fulvestrant (every 28 days,
250 mg/day, intramuscular) was given after her symptoms
had improved. She had been applied fulvestrant for five
months; however, she died because of disease progres-
sion at the sixth month of DI diagnosis.
BREAST CANCER WITH DIABETES INSIPIDUS
M. Dogan¹,, E. Karakilic², I.I. Oz³, F. Zorlu4, H. Akbulut¹, *
1Ankara University School of Medicine, Departments of Medical Oncology
2Internal Medicine, 3Radiodiagnostic, Ankara 06590, Turkey
4Hacettepe University School of Medicine, Department of Radiation Oncology, Ankara 06100, Turkey
Diabetes insipidus (DI) is a rare clinical condition, which is usually caused by neurohypophyseal or pituitary stalk infiltration
in cancer patients. Case report: we present a 62-year old metastatic breast cancer woman with DI. She admitted to the hospital
because of nausea, vomiting, polyuria and polydipsia, while she was on no cytotoxic medication. She had no electrolyte imbalance
except mild hypernatremia. The CT scan of the brain yielded a suspicious area in pituitary gland. A pituitary stalk metastasis was
found on magnetic resonance imaging (MRI) of pituitary. Water deprivation test was compatible with DI. A clinical response to
nasal vasopressin was achieved. Conclusions: Cancer patients who have symptoms such as nausea, vomiting, polyuria and polydipsia
while they are not on chemotherapy should be evaluated for not only metabolic complications like hypercalcemia but also posterior
pituitary or stalk metastasis MRI could be the choice of imaging for pituitary metastasis.
Key Words: cancer, diabetes insipidus, pituitary metastasis.
Received: October 16, 2008.
*Correspondence: Fax: 00903123192283
E-mail: mutludogan1@yahoo.com
Abbreviations used: AVP — arginine vasopression; BCT — CT scan
of the brain; DI — diabetes insipidus; MRI — magnetic resonance
imaging.
Exp Oncol 2008
30, 4, 324–326
SHoRT CommUNICATIoN
Experimental Oncology 30, 324–326, 2008 (December) 325
Fig. 1. A suspicious enhancement in pituatry gland was found
on CT after intravenous contrast injection
a
b
Fig. 2. A lesion including cystic component on posterior part of
stalk was found on coronal (a) and midsagittal (b) MR sections
of the cranium after intravenous contrast injection
Metastasis to the pituitary gland is an uncommon
site of metastasis of cancer. Breast and lung cancer
are the two most common tumours that spread to the
pituitary gland. Diabetes insipidus is rare in cancer
patients. Teears et al. [4], reported that 69,3% of
88 cancer patients with hypophyseal metastasis had
posterior pituitary alone or both anterior and posterior
pituitary metastasis, and 6,8% of them had DI. Pituitary
MRI is the most useful imaging modality for pituitary
pathologies [5]. Hypophysis, stalk, cavernous sinuses,
sphenoid sinus and optic chiasma are well evaluated
on coronal and sagittal T1-weighted MRI both before
and after Gadolonium injection [6]. Lesions on MRI may
be seen as cystic, nodular or stalk thickening. Poullin
et al., [7] concluded that a patient who had been dia-
gnosed breast cancer 10 years ago had DI secondary
to pituitary metastasis according to the symptoms,
such as polydipsia and polyuria, with stalk thickening
on pituitary MRI. Furthermore, the patient improved
after AVP application [7]. Hypophyseal, especially stalk,
pathologies may not be so clear on BCT. Our patient
was suspected for pituitary metastasis on BCT, but it
was more definitive on MRI. Radiotherapy is among the
treatment modalities of pituitary metastasis. However,
gamma-knife or cyber-knife is also available for the
patients who had been treated with radiotherapy before.
Piedra et al. [8] reported that treatment necessity of
a cancer patient with DI related to stalk metastasis de-
creased after gamma-knife. We also applied cyberknife
with 15 Gy. In spite of good response to treatment, the
breast cancer patients with pitiuitary metastasis and
DI have poor prognosis with a median survival time of
6 months [9, 10]. The diagnosis of DI should be kept in
mind in breast cancer patients with symptoms of serious
nausea, vomiting, polyuria and polydipsia.
REFERENCES
1. Majzoub JA, Srivatsa A. Diabetes insipidus: clinical and
basic aspects. Pediatr Endocrinol Rev 2006; 4: 60–5.
2. Robertson GL. Disorders of the neurohypophysis. In:
Kaper DL, Braunwald E, Fauci AS, hauser SL, Longo DL,
Jameson JL, eds. 16th Ed. Harrison’s Principles of Internal
Medicine. The United States of America: the McGraw-Hill
Companies, 2005: 2098.
3. Granata A, Figura M, Gulisano S, et al. Central diabetes
insipidus as a first manifestation of lung adenocarcinoma. Clin
Ter 2007; 158: 519–22.
4. Teears RJ, Silverman EM. Clinicopathologic review of
88 cases of carcinoma metastatic to the pituitary gland. Cancer
1975; 36: 216–20.
5. Chaudhuri R, Twelves C, Cox TC, Bingham JB. MRI
in diabetes insipidus due to metastatic breast carcinoma. Clin
Radiol 1992; 46: 184–8.
6. Melmed S, Jameson JL. Disorders of the anterior
pituitary and hypothalamus. In: Kaper DL, Braunwald E,
Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. 16th Ed.
Harrison’s Principles of Internal Medicine. The United States
of America: the McGraw-Hill Companies, 2005: 2082.
7. Poullin P, Di Costanzo V, Le Pommelet C, Gabriel B.
Diabetes insipidus disclosing metastasis of breast adenocar-
cinoma. Rev Med Interne 1995; 16: 444–6.
8. Piedra MP, Brown PD, Carpenter PC, Link MJ. Reso-
lution of diabetes insipidus following gamma knife surgery
326 Experimental Oncology 30, 324–326, 2008 (December)
for a solitary metastasis to the pituitary stalk. Case report.
J Neurosurg 2004; 101: 1053–6.
9. Morita A, Meyer FB, Laws ER. Symptomatic pituitary
metastases. J Neurosurg 1998; 89: 69–73.
10. Kurkjian C, Armor JF, Kamble R, et al. Symptomatic
metastases to the pituitary infundibulum resulting from pri-
mary breast cancer. Int J Clin Oncol 2005; 10: 191–4.
РАК Молочной железы ПРИ неСАХАРноМ ДИАБеТе
Несахарный диабет (DI) — редкое клиническое состояние, вызываемое инфильтрацией нейрогипофизарной ножки или
ножки гипофиза у онкологических больных. Описание случая: в исследовании рассмотрен случай выявления DI у 62-летней
женщины, у которой был выявлен рак молочной железы с наличием метастазов. Она поступила в больницу с симптомами
тошноты, рвоты, полиурии и полидипсии, хотя не проходила курса химиотерапии. У больной не выявлено дисбаланса
электролитов, кроме небольшой гипернатриемии. Компьютерная томография мозга показала подозрительную область
в мозговом придатке. На магнитно-резонансном изображении выявлен метастаз в ножке гипофиза. Обезвоживание также
соответствовало диагнозу DI. Получен клинический ответ на назальный вазопрессин. Выводы: онкологические больные
с симптомами тошноты, рвоты, полиурии и полидипсии, не проходящие курса химиотерапии, должны быть обследованы
не только на предмет метаболических осложнений, таких как гиперкальциемия, но и на возможное наличие метастазов
в ножке и задней части гипофиза с помощью магнитно-резонансного изображения.
Ключевые слова: рак, несахарный диабет, метастаз в гипофизе.
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