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Peer-reviewedCC BY-NCJournal of Brown hospital medicine

From Lethargy to Recovery: Central Diabetes Insipidus from Pituitary Metastasis in Recurrent HER2-Positive Breast Cancer Treated with Fam-Trastuzumab Deruxtecan-Nxki

  • Sushrut Ingawale1
  • Yasheen Gao2
  • Kirit Dhanjal3
  • Barbara Addi4
  • Kyung Ho Kim5
  • Sandhya Dhanjal6
6 affiliations
  1. 1Department of Internal Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States
  2. 2Quinnipiac University - Frank H. Netter, MD School of Medicine, North Haven, Connecticut, United States
  3. 3Union College, Schenectady, New York, United States
  4. 4Department of Oncology St. Vincent’s Medical Center, Bridgeport, Connecticut, United States
  5. 5Department of Medicine Quinnipiac University - Frank H. Netter, MD School of Medicine - St. Vincent’s Medical Center, Bridgeport, Connecticut, United States
  6. 6Department of Oncology Quinnipiac University - Frank H. Netter, MD School of Medicine - St. Vincent’s Medical Center, Bridgeport, Connecticut, United States
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Abstract

HER2-positive breast cancer is well known for its aggressive nature and high incidence of central nervous system (CNS) metastasis, often affecting the brain parenchyma or leptomeninges. However, metastasis to the pituitary gland is exceedingly rare. We report a case of ER/PR-negative, HER2-positive breast cancer recurrence presenting with panhypopituitarism (PH) and central diabetes insipidus (CDI), resulting in hypernatremia-induced altered mental status. The patient had completed prior treatment with neoadjuvant chemotherapy, lumpectomy, and trastuzumab. Imaging revealed a temporal lobe mass with suprasellar enhancement. Surgical resection confirmed breast carcinoma metastasis. Hormonal studies confirmed PH and CDI. Management involved DDAVP, corticosteroids, fluid correction, whole-brain radiation, and systemic therapy with fam-trastuzumab deruxtecan-nxki (ENHERTU), leading to significant neurological recovery. This case highlights a rare metastatic pattern and the need for high clinical suspicion and multidisciplinary intervention.

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Cite

BibTeXRIS
BibTeX
@article{ingawale2026from,
  title = {{From Lethargy to Recovery: Central Diabetes Insipidus from Pituitary Metastasis in Recurrent HER2-Positive Breast Cancer Treated with Fam-Trastuzumab Deruxtecan-Nxki}},
  author = {Sushrut Ingawale and Yasheen Gao and Kirit Dhanjal and Barbara Addi and Kyung Ho Kim and Sandhya Dhanjal},
  journal = {Journal of Brown hospital medicine},
  year = {2026},
  month = oct,
  doi = {10.56305/001c.168604},
  url = {https://europepmc.org/article/PMC/PMC13730608},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - From Lethargy to Recovery: Central Diabetes Insipidus from Pituitary Metastasis in Recurrent HER2-Positive Breast Cancer Treated with Fam-Trastuzumab Deruxtecan-Nxki
AU  - Sushrut Ingawale
AU  - Yasheen Gao
AU  - Kirit Dhanjal
AU  - Barbara Addi
AU  - Kyung Ho Kim
AU  - Sandhya Dhanjal
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Brown hospital medicine
DO  - 10.56305/001c.168604
UR  - https://europepmc.org/article/PMC/PMC13730608
AB  - HER2-positive breast cancer is well known for its aggressive nature and high incidence of central nervous system (CNS) metastasis, often affecting the brain parenchyma or leptomeninges. However, metastasis to the pituitary gland is exceedingly rare. We report a case of ER/PR-negative, HER2-positive breast cancer recurrence presenting with panhypopituitarism (PH) and central diabetes insipidus (CDI), resulting in hypernatremia-induced altered mental status. The patient had completed prior treatment with neoadjuvant chemotherapy, lumpectomy, and trastuzumab. Imaging revealed a temporal lobe mass with suprasellar enhancement. Surgical resection confirmed breast carcinoma metastasis. Hormonal studies confirmed PH and CDI. Management involved DDAVP, corticosteroids, fluid correction, whole-brain radiation, and systemic therapy with fam-trastuzumab deruxtecan-nxki (ENHERTU), leading to significant neurological recovery. This case highlights a rare metastatic pattern and the need for high clinical suspicion and multidisciplinary intervention.
SN  - 2994-5593
ER  -