Neurosarcoidosis presenting with panhypopituitarism: diagnostic and therapeutic challenges: a case report

BACKGROUND: Neurosarcoidosis is a rare but serious manifestation of sarcoidosis involving the central nervous system. When it affects the hypothalamic-pituitary axis, it can result in panhypopituitarism and diabetes insipidus due to disruption of anterior and posterior pituitary hormone regulation. Early recognition is critical, as delayed diagnosis may lead to life-threatening complications. CASE PRESENTATION: We report the case of a 42-year-old White man with a 12-year history of sarcoidosis who presented with abdominal pain, hypotension, hypothermia, hypernatremia, polyuria, and polydipsia. He also had widespread skin plaques, joint pain, and cartilage deformities. Notably, he had developed drug-resistant seizures 3 years earlier. Laboratory investigations demonstrated hypernatremia, low urine osmolality, and hormonal deficiencies consistent with panhypopituitarism. Imaging revealed suprasellar and brainstem lesions. After excluding alternative diagnoses, neurosarcoidosis was established. The patient responded well to hormone replacement therapy with levothyroxine and desmopressin, which led to clinical improvement. CONCLUSION: This case highlights the importance of considering neurosarcoidosis in patients with sarcoidosis who develop endocrine or neurological symptoms. It underscores the value of timely diagnosis and multidisciplinary management to prevent irreversible complications and improve long-term outcomes.