Suprasellar Mass Lesions Presenting with Central Diabets Insipidus

ABSTRACT

Central diabetes insipidus(CDI) may result from any abnormalities in the supraoptic-neuropituitary axis. Since 1984, we have studied 7 suprasellar mass lesions presenting with CDI. There were 3 suprasellar germinomas including 1 pituitary stalk(infundibular) microgerminoma, 1 suprasellar lymphoma, 1 craniopharyngioma, 2 suprasellar mass lesions whose pathologies were not confirmed. In two case of germinoma, one at infundibulum and another at suprasellar region, the diagnosis was made on the basis of radiological and endocrinological findings and rapid disappearance of the mass after irradiation. The symptoms of CDI had improved within 2 months after the irradiation in all 3 cases of germinoma. Another 4 cases had been on DDAVP during follow-up periods more than one year. Primary tumorous lesions presenting with CDI always demonstrate pituitary stalk enlargement, suprasellar mass, or both. Among parasellar lesions presenting with CDI, germinoma and lymphoma are very sensitive to radiotherapy and have no need of surgery which and result in pituitary stalk damage and permanent CDI. And lesions of infectious and systemic disease also have no need of surgery. To avoid unnecessary surgery or biopsy, preoperative differential diagnosis of these lesions by CT scan findings and other systemic evaluations is important. In addition, elevation of serum prolactin level appeared to be related to infundibular lesions as a few authors suggested previously but not to aid differential diagnosis.