Abstract
BACKGROUND: Paraneoplastic syndromes are rare complications associated with malignancies, and central diabetes insipidus represents one of their uncommon manifestations. Central diabetes insipidus is most frequently observed in association with specific malignancies, such as lung cancer, and often results from metastatic involvement of the pituitary gland and the sellar region. CASE PRESENTATION: A 50-year-old Iranian male presented to the hospital with complaints of polyuria and polydipsia, which had begun 20 days prior to admission. Initial outpatient evaluation revealed a urine specific gravity of 1.008 and a serum sodium level of 148 mEq/L. Upon hospital admission, physical examination provided limited diagnostic information, and the patient's vital signs were stable. Desmopressin nasal spray was initiated, leading to a marked improvement in symptoms, supporting a presumptive diagnosis of central diabetes insipidus. Brain magnetic resonance imaging was subsequently performed, which showed no abnormalities in the pituitary gland or adjacent structures. However, lesions were identified in the right rectus gyrus and left occipital lobe. Further evaluation with chest computed tomography and transbronchial lung biopsy confirmed a diagnosis of lung adenocarcinoma. Despite receiving platinum-based chemotherapy, the patient did not respond to treatment and ultimately succumbed to the illness. CONCLUSION: Clinicians should maintain a high index of suspicion for paraneoplastic syndromes when encountering a sudden onset of rare clinical conditions, such as central diabetes insipidus. Early recognition of these manifestations can facilitate timely cancer diagnosis and prompt initiation of appropriate therapy.