Autoimmune hypophysitis treated with intravenous glucocorticoid therapy.
A 46-year-old man presented with frontal headache, a visual field defect and general fatigue. Magnetic resonance imaging (MRI) of the brain showed symmetrical enlargement of the pituitary gland and stalk due to the presence of a mass lesion extending toward the optic chiasm. Gadolinium injection further revealed homogeneous strong enhancement with involvement of the adjacent dura (dural tail). Basal plasma levels of ACTH, free thyroxine and gonadotropins were decreased, and 24-h urinary 17-OHCS excretion was reduced. An elevated anti-thyroglobulin antibody titer indicated the presence of autoimmune thyroiditis. Under the suspicion of autoimmune hypophysitis, 60 mg/day prednisolone sodium succinate was intravenously administered for two weeks followed by a decreasing dose of oral prednisolone. Clinical symptoms and pituitary dysfunction recovered during steroid treatment and MRI showed marked shrinkage of the pituitary mass. Early initiation of an intravenous dose of glucocorticoid followed by oral steroid administration therefore seems to be an efficient treatment for autoimmune hypophysitis even in patients with visual dysfunction.
Miyake
Ikuyo
I
Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine.
Takeuchi
Yasuharu
Y
Kuramoto
Terukazu
T
Kaku
Hiroo
H
Nakayama
Hitomi
H
Takata
Kazuna
K
Kurita
Yayoi
Y
Shigemori
Minoru
M
Hiromatsu
Yuji
Y
Yamada
Kentaro
K
D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000188:drug therapy*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged
D005938:Glucocorticoids