Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus
Central diabetes insipidus is an uncommon feature of malaria. A previously healthy 72-year-old man presented with fever, rigors, and altered mental status after a recent trip to Liberia, a country known for endemic falciparum malaria. Investigations confirmed plasmodium falciparum parasitemia. Withi...
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doaj-0c1182b72d1740969895b84342c32e3a2020-11-25T00:21:29ZengHindawi LimitedCase Reports in Endocrinology2090-65012090-651X2016-01-01201610.1155/2016/20474102047410Cerebral Malaria: An Unusual Cause of Central Diabetes InsipidusResmi Premji0Nira Roopnarinesingh1Joshua Cohen2Sabyasachi Sen3Division of Endocrinology, Diabetes and Metabolism, George Washington University, Washington, DC 20037, USADivision of Endocrinology, Diabetes and Metabolism, George Washington University, Washington, DC 20037, USADivision of Endocrinology, Diabetes and Metabolism, George Washington University, Washington, DC 20037, USADivision of Endocrinology, Diabetes and Metabolism, George Washington University, Washington, DC 20037, USACentral diabetes insipidus is an uncommon feature of malaria. A previously healthy 72-year-old man presented with fever, rigors, and altered mental status after a recent trip to Liberia, a country known for endemic falciparum malaria. Investigations confirmed plasmodium falciparum parasitemia. Within one week after admission, the serum sodium rose to 166 mEq/L and the urine output increased to 7 liters/day. Other labs were notable for a high serum osmolality, low urine osmolality, and low urine specific gravity. The hypernatremia did not respond to hypotonic fluids. Diabetes insipidus was suspected and parenteral desmopressin was started with a prompt decrease in urinary output and improvement in mental status. Additional testing showed normal anterior pituitary hormones. The desmopressin was eventually tapered off with complete resolution of symptoms. Central diabetes insipidus occurred likely as a result of obstruction of the neurohypophyseal microvasculature. Other endocrinopathies that have been reported with malaria include hyponatremia, adrenal insufficiency, hypothyroidism, hypocalcemia, hypophosphatemia, hyper-, and hypoglycemia, but none manifested in our patient. Though diabetes insipidus is a rare complication of malaria, clinicians need to be aware of this manifestation, as failure to do so may lead to fatality particularly if the patient is dehydrated.http://dx.doi.org/10.1155/2016/2047410 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Resmi Premji Nira Roopnarinesingh Joshua Cohen Sabyasachi Sen |
spellingShingle |
Resmi Premji Nira Roopnarinesingh Joshua Cohen Sabyasachi Sen Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus Case Reports in Endocrinology |
author_facet |
Resmi Premji Nira Roopnarinesingh Joshua Cohen Sabyasachi Sen |
author_sort |
Resmi Premji |
title |
Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus |
title_short |
Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus |
title_full |
Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus |
title_fullStr |
Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus |
title_full_unstemmed |
Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus |
title_sort |
cerebral malaria: an unusual cause of central diabetes insipidus |
publisher |
Hindawi Limited |
series |
Case Reports in Endocrinology |
issn |
2090-6501 2090-651X |
publishDate |
2016-01-01 |
description |
Central diabetes insipidus is an uncommon feature of malaria. A previously healthy 72-year-old man presented with fever, rigors, and altered mental status after a recent trip to Liberia, a country known for endemic falciparum malaria. Investigations confirmed plasmodium falciparum parasitemia. Within one week after admission, the serum sodium rose to 166 mEq/L and the urine output increased to 7 liters/day. Other labs were notable for a high serum osmolality, low urine osmolality, and low urine specific gravity. The hypernatremia did not respond to hypotonic fluids. Diabetes insipidus was suspected and parenteral desmopressin was started with a prompt decrease in urinary output and improvement in mental status. Additional testing showed normal anterior pituitary hormones. The desmopressin was eventually tapered off with complete resolution of symptoms. Central diabetes insipidus occurred likely as a result of obstruction of the neurohypophyseal microvasculature. Other endocrinopathies that have been reported with malaria include hyponatremia, adrenal insufficiency, hypothyroidism, hypocalcemia, hypophosphatemia, hyper-, and hypoglycemia, but none manifested in our patient. Though diabetes insipidus is a rare complication of malaria, clinicians need to be aware of this manifestation, as failure to do so may lead to fatality particularly if the patient is dehydrated. |
url |
http://dx.doi.org/10.1155/2016/2047410 |
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