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Tani M, Hiroshima S, Sato H, Sawano K, Ogawa Y, Imamura M, Oishi M, Nagasaki K. Infantile-Onset Isolated Neurohypophyseal Langerhans Cell Histiocytosis with Central Diabetes Insipidus: A Case Report. CHILDREN 2022; 9:children9050716. [PMID: 35626895 PMCID: PMC9139757 DOI: 10.3390/children9050716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
Central diabetes insipidus (CDI) is a rare disease in children and has a variety of etiologies. The major causes of CDI with pituitary stalk thickening (PST) are germinoma, Langerhans cell histiocytosis (LCH), and Lymphocytic infundibulo-neurohypophysitis, which are difficult to differentiate by imaging and require pathological diagnosis. We report a case of infantile-onset isolated neurohypophyseal LCH diagnosed by pathological findings. A 2-year-old girl presented with polydipsia and polyuria. CDI was diagnosed and treatment with oral desmopressin was initiated. Magnetic resonance imaging (MRI) of the head showed PST and absence of high-signal intensity of posterior pituitary on T1-weighted images. Follow-up MRI scans showed that the tumor mass was gradually increasing and extending posteriorly toward the area near the mamillary body. Simultaneously, anterior pituitary dysfunction was observed. She underwent a biopsy of the PST and LCH was diagnosed by immunohistochemical analysis. DNA analysis showed no BRAF V600E mutation. Monotherapy with 2-Chlorodeoxyadenosine reduced the tumor size but did not improve pituitary function. Isolated neurohypophyseal LCH should be considered in infantile-onset cases of CDI with PST. 2-CdA treatment resulted in rapid PST shrinkage. Further cases are needed to determine whether early diagnosis and treatment can prevent anterior pituitary dysfunction.
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Affiliation(s)
- Mizuki Tani
- Department of Pediatrics, Niigata Prefectural Shibata Hospital, Niigata 957-8588, Japan; (M.T.); (H.S.)
| | - Shota Hiroshima
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Hidetoshi Sato
- Department of Pediatrics, Niigata Prefectural Shibata Hospital, Niigata 957-8588, Japan; (M.T.); (H.S.)
| | - Kentaro Sawano
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Yohei Ogawa
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Masaru Imamura
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata 951-8510, Japan;
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (S.H.); (K.S.); (Y.O.); (M.I.)
- Correspondence: ; Tel.: +81-025-227-2222
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