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Polydipsia/Polyuria with Cervical Lymphadenopathy and Hypercalciuria

I just turned 41, and I'm male.  I have been having progressively increasing thirst with high urine output.  Now, I have dry mouth and excessive thirst.  My dry mouth was even noticed by my dentist.  Worried it might be diabetes insipidus (which can have many serious causes).  I have trouble swallowing food.

Single enlarged posterior cervical lymph node (right side of neck)--I found it on Oct 3--so it's been there a month (possibly longer--since it is non-tender.  After 3 weeks, I saw an ENT, who seemed not too concerned.  After 2 weeks and antibiotics that did nothing, I saw him again, and he did scope of nasopharynx and still wasn't too concerned.  He said an ultrasound guided fine needle aspiration biopsy (FNA) would be reasonable. The next week on the day before the FNA, I got an upper respiratory infection (could this infection caused my node enlargement prior to symptoms being obvious?).  During the FNA, the node was measured as 2.5 cm x 1.6 cm x 0.5 cm.  Pathology report was inconclusive--but radiologist told my ENT the node had benign characteristics.  He said its hilum was intact (which much more often a sign of being benign).  Now the node feels like it changes in size (seems to grow overnight and shrink during waking hours).  My respiratory infection is mostly gone--occasional dry cough and clearing throat, but the node is still there.

Other issues and symptoms
Kidney stones (4 mm calcium oxalate stone passed on 9/1; after that I had renal ultrasound showing 4 more in left kidney measuring 8 mm, 2x9mm, and 10mm--still there now).  In my 24 hr urine collection test, I had low fluid intake--was concerned about not having enough room in container (4 cans of diet ginger ale--about 1.5L and still had high output of 2.3).  That was after I had to repeat 24 hr collection for not refrigerating--and the first time I had 3.3 L, when I didn't restrict.

All started after my weight loss process---from 368 to 280 (90 lbs) after having physical, and my blood tests showed pre-diabetic fasted glucose and high cholesterol, so I went on an aggressive diet.

-Gynecomastia--6 months or so, I noticed left mass in left breast (ultrasound said gynecomastia and BI-RADS 3 probably benign)  Saw endocrinolgist who said my prolactin was normal, but I had low T (77), which he attributed to obesity.  Research shows rapid weight loss can also drop serum T (and led to gynecomastia).
-Dry sinuses--recurring blood in mucus.  Earlier this year it gave me a lung cancer scare.  Had a chest CT Scan, which was clean (6 months ago--mild aortic calcification and gynecomastia noted).
-Tender spot on left shoulder--noticed this recently
-Gallstones (silent--showed on on recent renal ultrasound for my stones)
-Exposure to cat scratch--had one Bartonella antigen test after a round of antibiotics, which was negative--rough housed over past year and got many scratches from cat.  Cat shows signs of systemic disease (eye leak and long sneezing fits--sometimes 20+ times).
-Skin issues
   About 6-7 weeks ago, I had generalized itching for weeks, but it went away eventually.
   About 5-6 months ago, I had excessively dry sking--that even scaled, but it also went away eventually.
   Within the past year, I had 3 red spots on my external skin (back, side of hip, and right shin), that dermatoligst froze off.
   2-3 months a red spot appeared under my right knee cap.  I recall it itching at the time--the red spot is still there not but below the surface--and it blanches (fades away temporarily) when I press on it.

In my limited knowledge using the internet to do research, I see the following possibilities:
  Cancer that has infiltrated (or originated in) the brain causing diabetes insipidus and possibly the low T (and resulting gynecomastia)----indications are lymph node, low T, and the kidney stones (can affect calcium metabolism)--contraindicated by normal prolactin, TSH?
  Sarcoidosis which could cause diabetes insipidus (via brain or via kidney--both are possible)--indications are lymph node, skin issues, and hypercalciuria (can affect calcium metabolism)--contraindicated by chest CT 6 months ago with no lung infiltration.
  Other granulomatous infection (possible cat scratch--usually self limiting but did rapid weight loss make me immunocompromised?--or toxoplasmosis or other)--indications same as sarcoidosis.
  Sjogren's syndrome (favors females--but men do get it, and I have low T) which could cause both diabetes insipidus (kidney type) or primary polydipsia (dry mouth causing excessive thirst)--indications are dry skin, dry mouth, kidney stones, can cause lymphadenopathy, can cause gallstones--contraindicated by male sex.
  Unusually persistent infection--indicated by dehydration and lymph node--and condition possibly complicated by temporary post-obstructive renal diabetes insipus caused by passing a kidney stone on 9/1 (although this is a rare).
1 Responses
Avatar universal
Some Lab values from 10/3 (unless otherwise)
High urine calcium (414) with high normal serum calcium (trend--9.6 on 3/21; 9.9 on 7/9; 10.2 on 8/29; 10.0 on 10/3 - ionized Ca 4.9 on 10/3)
Low normal PTH 21 (despite vitamin D deficiency of 15 with a D 125 high normal of 54)
Low urine specific gravity (1.005) and low in range urine osmolality (317) -- -
High serum sodium -- 144 top end of normal range (and this was before the excessive thirst)
Low almost non-existent urinary cystine -- any significance?
Elevated serum phosphorous 4.9
Urine pH 6.9
Low T 77 (on 8/29)
Normal prolactin 5.5 (on 8/29)
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