Central Diabetes Insipidus – An Uncommon Presentation of Acute Myeloid Leukaemia: A Case Report and Literature Review

Introduction: Central diabetes insipidus (CDI) is a rare manifestation of Acute myeloid leukaemia (AML). Patients can present with polyuria, polydipsia, weight loss and electrolyte disturbances either at the time of diagnosis or while on treatment. Due to the underlying haematological malignancy, management of this condition might become challenging.

Case Summary: We report a 65-year-old gentleman diagnosed with acute myeloid leukaemia. Post 2 cycles of azacytidine therapy, he presented with polyuria, polydipsia and weight loss.

On evaluation, he was diagnosed with CDI after performing water deprivation test and correlating biochemical parameters. Concurrent MRI of the brain showed well defined homogeneously enhancing posterior pituitary lesions suggestive of leukemic deposits confirming the diagnosis of CDI.

Diagnosis of diabetes insipidus (DI) was made 2 months after the diagnosis of AML. The patient was started on oral desmopressin at a dose of 0.2 mg per day. Upon initiation of the therapy there was significant relief of symptoms. He was simultaneously continued on therapy with hypomethylating agent (Azacytidine) and Venetoclax for AML. Upon initiation of therapy, the symptoms significantly subsided. He continued receiving treatment for AML with Venetoclax and azacytidine. However, the patient succumbed to the disease 9 months post the diagnosis of CDI.

Conclusion: AML- M4/M5 with monocytic differentiation have a propensity to invade various extramedullary tissues, including the skin, gingiva, brain, and endocrine organs. If patients with AML present with symptoms of increased urination, excessive thirst, and weight loss, it is crucial to consider the possibility of CDI and conduct a thorough assessment for this condition.