Occurrence of IgG4-related hypophysitis lacking IgG4-bearing plasma cell infiltration during steroid therapy.
Eight years after an episode of multiple IgG4-related disease, a pituitary mass with panhypopituitarism and a visual disturbance developed in a 70-year-old man under low-dose steroid therapy. A pituitary biopsy revealed findings of lymphocytic hypophysitis with the absence of IgG4-positive plasma cell infiltration. The serum IgG4 level was unremarkable. Although performing a pituitary biopsy and measuring the serum IgG4 level is crucial for making a diagnosis of IgG4-related hypophysitis, it is occasionally difficult to diagnose the disease in patients treated with steroid therapy, as observed in the present case. Based on a review of the diagnosis, conducting a careful assessment is required, especially in men and elderly patients thought to have solitary hypophysitis.
Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Shinshu University School of Medicine, Japan.
Yohsuke
Y
Ohkubo
Takashi
T
Sekido
Keiko
K
Takeshige
Hiroaki
H
Ishi
Masahiro
M
Takei
Shin-ichi
S
Nishio
Masanori
M
Yamazaki
Mitsuhisa
M
Komatsu
Shigeyuki
S
Kawa
Satoru
S
Suzuki
D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy; D007074:Immunoglobulin G / Q000097:blood* / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D010900:Pituitary Diseases / Q000097:blood / Q000139:chemically induced* / Q000276:immunology; D010902:Pituitary Gland / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D010950:Plasma Cells / Q000276:immunology* / Q000378:metabolism
D005938:Glucocorticoids; D007074:Immunoglobulin G