title: Erdheim-Chester disease and pituitary involvement: a unique case and the literature.
abstract: An early thirties man diagnosed with Erdheim-Chester disease (ECD) was simultaneously disclosed to have hypogonadotropic hypogonadism, central adrenal insufficiency, and GH deficiency in addition to central diabetes insipidus (CDI). Pituitary magnetic resonance imaging (MRI) showed swelling in the stalk, enlargement of the anterior lobe with delayed enhancement, and loss of high intensity of the posterior lobe on T1-weighted images, suggesting of pituitary involvement of ECD. Three months after starting treatment with interferon α and zoledronic acid, polyuria and polydipsia were ameliorated without DDAVP, accompanied with improvement of MRI. Simultaneously technetium-99m bone scintigraphy showed improvement, accompanied with a relief of bone pain and high fever. In contrast, he developed secondary hypothyroidism with slight enlargement of anterior pituitary gland without relapse of CDI, suggesting of different responses to treatment with interferon α between anterior pituitary lobe and posterior one. So far he continues to be replaced with deficient hormone replacement therapy. As for bone pain, it remains to be controlled with the decreased levels of bone resorption marker with decreased abnormal uptake in bone scintigraphy although zoledronic acid was discontinued for osteonecrosis of the jaw. For four years, he has not showed new involvement at other organs besides bones and the pituitary. While CDI is known to be very common in ECD, improvement of CDI has been reported in a few cases. Other endocrine manifestations, especially with detailed endocrine status, have been also reported in limited cases. Thus we report this case and review the literature.
authors.affiliation: Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo 113-8655 Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Manaka
authors.forename: Noriko
authors.initials: N
authors.lastname: Makita
authors.forename: Taroh
authors.initials: T
authors.lastname: Iiri
mesh_terms: D000328:Adult; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology; D003409:Congenital Hypothyroidism / Q000209:etiology; D020790:Diabetes Insipidus, Neurogenic / Q000473:pathology; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D031249:Erdheim-Chester Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology*; D007037:Hypothyroidism; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D010902:Pituitary Gland / Q000473:pathology; D010903:Pituitary Gland, Anterior / Q000473:pathology*; D013972:Thyrotropin / Q000172:deficiency; D000077211:Zoledronic Acid
chemical_list: D004164:Diphosphonates; D007093:Imidazoles; D016898:Interferon-alpha; D000077211:Zoledronic Acid; D013972:Thyrotropin