title: Hypopituitarism and diabetes insipidus with localized hypertrophic pachymeningitis (Tolosa-Hunt syndrome) associated with Hashimoto thyroiditis.
abstract: We report a 69-year-old woman with intracranial pachymeningitis showing hypopituitarism, diabetes insipidus, and Tolosa-Hunt syndrome associated with Hashimoto thyroiditis confirmed by autopsy. A large tumorous lesion of the hypothalamo-pituitary gland was revealed on magnetic resonance imaging, after the patient complained of gait and visual field disturbance. These symptoms subsided after thyroid hormone supplementation. Hypopituitarism and diabetes insipidus were diagnosed after cessation of the treatment by the patient herself. Multiple cranial nerve palsies and orbito-frontalgia appeared. Methylprednisolone pulse therapy improved the symptoms, but they recurred when the dose of glucocorticoid was decreased. The patient died of brain thrombosis. Autopsy revealed typical findings of Hashimoto thyroiditis and intracranial pachymeningitis involving the cranial base and pituitary gland. The high titer of rheumatoid factor and Hashimoto thyroiditis in this patient suggest an immunological role in the pathogenesis of pachymeningitis.
authors.affiliation: Department of Internal Medicine, Matsunami Generl Hospital, Kasamatsu, Japan. nyamakita@matsunami-hsp.or.jp
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Yamakita
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hanamoto
authors.forename: Noriaki
authors.initials: N
authors.lastname: Muraoka
authors.forename: Tsuneko
authors.initials: T
authors.lastname: Ikeda
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hirata
authors.forename: Keigo
authors.initials: K
authors.lastname: Yasuda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sano
mesh_terms: D000368:Aged; D020790:Diabetes Insipidus, Neurogenic / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology*; D007029:Hypothalamic Neoplasms / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000209:etiology; D013967:Thyroiditis, Autoimmune / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D013974:Thyroxine / Q000627:therapeutic use; D014794:Visual Fields / Q000187:drug effects / Q000502:physiology
chemical_list: D013974:Thyroxine