Poster Presentation ESA-SRB-APEG-NZSE 2022

Polyuria and Acute Myeloid Leukaemia – an Unusual Cause of Central Diabetes Insipidus (#319)

Arunan Sriravindrarajah 1 2 , Beryl Lin 1 3 , Jessica Bindra 2 4 , Anne Maree Kean 2 , Cale Burge 3 , Edward Abadir 1 3 , Stephen Twigg 1 2 5
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Department of Endocrinology and Metabolism, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. School of Medicine, Western Sydney University, Sydney, NSW, Australia
  5. Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia

Background: Central diabetes insipidus (DI) occurs due to inadequate secretion of antidiuretic hormone (ADH) from the neurohypophysis resulting in hypotonic polyuria and hypernatraemia.1 Acquired central DI can occur due to disturbance of the neurohypophysis such as trauma, infection, ischaemia or malignancy.  Acute myeloid leukaemia (AML) can be a rare, acquired cause of central DI.2 

Case: A 70-year-old Caucasian female was admitted with febrile neutropenia in the context of a 2-week history of polyuria and polydipsia, drinking up to 4L water daily. Initial blood film demonstrated >80% blasts, and the diagnosis of AML was confirmed by bone marrow biopsy. Cytogenetic analysis identified the inv(3q) and monosomy 7 karyotype. PET scan and biopsy also demonstrated leukaemic infiltration of the left submandibular lymph node. However, CSF cytology x3 did not identify any malignant cells. The diagnosis of DI was confirmed following overnight water deprivation, resulting in morning (0835) serum sodium 154mmol/L, serum osmolality 306mmol/L, urine sodium 37mmol/L, urine osmolality 146mmol/L and copeptin 3.2pmol/L. MRI Brain identified absence of the posterior pituitary bright spot with mild abnormal enhancement of the infundibulum and hypothalamus, which was suggestive of infiltration. Treatment was commenced with desmopressin. The dose required for stabilisation of urine output and serum sodium rapidly increased from 200mcg nocte to 200mcg mane/1000mcg nocte. She was treated with FLAG-Ida chemotherapy and intrathecal methotrexate, which was complicated by suspected cytarabine syndrome and colitis. Unfortunately, the patient developed neutropenic sepsis with progressive type 1 respiratory failure, and died upon transition to comfort care.

Conclusion: This case demonstrates the unusual situation of AML-induced central DI. The presence of inv(3q) and monosomy 7 chromosomal abnormalities are associated with the development of central DI, and is a poor prognostic marker.

  1. Diagnosis and management of central diabetes insipidus in adults. Garrahy, Moran and Thompson. 2019. Clinical Endocrinology, 90(1): 23-30.
  2. Central Diabetes Insipidus due to Acute Myeloid Leukaemia. Boston, Levine and Yatavelli. 2021. Journal of the Endocrine Society. 5(Supp.1): A575-6.