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  Central Diabetes Insipidus with Pituitary Stalk Thickening

  Ahsan Uddin and Shabana Kalladi Puthanpurayil

  Central diabetes insipidus (CDI) in children may be associated with a range of etiologies, including germinoma, Langerhans cell histiocytosis (LCH), and lymphocytic hypophysitis. Magnetic resonance imaging (MRI) has revealed isolated pituitary stalk thickening (PST) in some cases of idiopathic CDI. Among patients with CDI, anterior pituitary hormone deficiencies (APD) or progressive PST over time may be predictive of neoplasia. Because of the association of CDI and occult neoplasia, MRI plays an important role in the diagnostic evaluation of a child with CDI. Studies have shown that the degree of PST may vary depending on the underlying etiology. Definitive tissue diagnosis with a pituitary stalk biopsy poses challenges in itself. In this chapter, a diagnostic approach to children with CDI and PST is proposed that may help differentiate patients for whom closer surveillance is indicated from those whose PST is more likely due to inflammatory or non-neoplastic causes. We present an illustrative case of a child with new onset CDI, with MRI finding of a markedly thickened pituitary stalk.