title: IgG4-related hypophysitis presenting as a pituitary adenoma with systemic disease.
abstract: Hypophysitis is a rare inflammatory disorder that can mimic a pituitary tumor clinically or radiologically. Furthermore, immunoglobulin G4 (IgG4)-related systemic disease is only a just recently characterized disorder. It can manifest as a systemic disease involving multiple organs, including the pancreas, salivary glands, lungs, liver, bile duct, gallbladder, kidneys, and retroperitoneum. It is characterized by a high serum level of IgG4 clinically and dense lymphoplasmacytic infiltration with sclerosis and phlebitis histologically. Herein, we report the case of a man 66 years of age who presented with nausea, vomiting, and poor appetite with a body weight loss of 4 kg. Image study revealed a pituitary infundibulum mass, right-posterior mediastinal and paraspinal masses, as well as infiltrating masses in bilateral kidneys. Therefore, he received a thoracoscopic biopsy for the right-posterior mediastinal and paraspinal masses and a pathologic examination reported an IgG4-related inflammatory pseudotumor. Then, transsphenoidal removal of the infundibulum mass was performed. Histologically, the infundibulum mass represented a IgG4-related hypophysitis manifested as an infiltration of plasma cells, lymphocytes, histiocytes, and some eosinophils with a fair number of IgG4-immunoreactive plasma cells. After the operation was complete, the patient took 5 mg of prednisolone every 2 days for 3 months. A follow-up computed tomography scan revealed improvement of the infiltrating masses in the bilateral kidneys.
authors.affiliation: Department of Neurosurgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ming-Tai
authors.initials: MT
authors.lastname: Hsing
authors.forename: Hui-Ting
authors.initials: HT
authors.lastname: Hsu
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Cheng
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Chen
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000601:surgery; D000368:Aged; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007674:Kidney Diseases / Q000276:immunology; D008297:Male; D010900:Pituitary Diseases / Q000276:immunology* / Q000601:surgery; D010904:Pituitary Gland, Posterior / Q000276:immunology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000601:surgery; D012598:Sclerosis / Q000276:immunology / Q000473:pathology*; D013906:Thoracoscopy
chemical_list: D007074:Immunoglobulin G