Low-set osmotic threshold for vasopressin release in a patient with prolactinoma

This report describes a 38-year-old patient with prolactinoma, without adrenal or thyroid insufficiency, with syndrome of inappropriate secretion of vasopressin due to downward resetting of the hypothalamic osmoreceptors. Random measurements of plasma and urine osmolality revealed an inappropriately high urine osmolality for a given plasma osmolality. Simultaneous plasma vasopressin levels were within normal limits. Urine dilution after water load was normal. During infusion of hypertonic saline, the osmotic threshold was demonstrated at plasma osmolality of 267 mosmol/kg, which is markedly lower than the normal 287.3 +/- 3.3 mosmol/kg. Thirst sensation seemed to be intact. The defect in the osmoreceptor function might have been induced by the tumor mass or by chronic hyperprolactinemia.