Disclosures: Lucas W. Bider, MD: Nothing to disclose

Case Description: The patient was admitted to an inpatient rehabilitation facility after surgical decompression of the spinal canal and resection of a recurrent T12 giant cell tumor (GCT). She was diagnosed with a T10 AIS C SCI secondary to infiltration of the tumor into the cauda equina, anterior nerve roots, and conus medullaris. Rehabilitation was complicated by polydipsia, polyuria, and subsequent confusion. Fluid intake was restricted to 2 L per day; polyuria continued reaching 9 L in 24 hours. Urine osmolality was found to be 126 mos/kg despite water deprivation and concentration of plasma sodium >145 mEq/L. These studies were consistent with diabetes insipidus (DI), and desmopressin was administered resulting in correction of polyuria. In an effort to improve mentation the patient was also tapered off sedating medications, including oxycodone and gabapentin. Despite these interventions, the patient’s mental status continued to decline. She was transferred to acute care where imaging revealed a large suprasellar mass which appeared to be a metastatic tumor originating from the vertebral GCT.

Setting: Inpatient Rehabilitation Facility

Patient: 36-year-old pregnant female with spinal cord injury (SCI) secondary to giant cell tumor (GCT) of twelfth thoracic vertebra.

Assessment/Results: The patient’s rapid decline continued after transfer, necessitating an emergency C-section at 28 weeks due to fetal decelerations. Following delivery, the patient required intubation for acute hypoxic respiratory failure. After extensive interdisciplinary discussion with family, the patient was made comfort care.

Discussion: GCT of the bone is usually a benign, locally aggressive neoplasm. To our knowledge, only two previous cases of GCT with metastatic involvement of the brain have been reported. We are not aware of any previous cases of GCT metastases causing symptoms consistent with central DI.

Conclusion: The workup of central DI and cognitive changes in a patient with GCT should include evaluation for an intracranial lesion.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/brain-mass-endocrine-abnormalities-and-spinal-cord-injury-in-pregnant-patient-with-atypical-giant-cell-tumor-a-case-report/