title: Overlap of Post-obstructive Diuresis and Unmasked Diabetes Insipidus in a Case of IgG4-related Retroperitoneal Fibrosis and Tuberoinfundibular Hypophysitis: A Case Report and Review of the Literature.
abstract: The clinical picture of IgG4-related disease (IgG4-RD) is diverse because various organs can be affected. We describe the case of a 56-year-old man with acute renal failure and tuberoinfundibular hypophysitis due to IgG4-RD. Steroid therapy lowered the serum IgG4 level and ameliorated renal dysfunction, bilateral hydronephrosis and retroperitoneal fibrosis. However, polyuria from post-obstructive diuresis and unmasked central diabetes insipidus ensued. The patient's polyuria continued despite the administration of a therapeutic dose of glucocorticoid; the patient's pituitary swelling and anterior pituitary dysfunction were partially ameliorated. The pituitary swelling recurred seven months later. In patients with IgG4-RD, the manifestation of polyuria after steroid therapy should prompt suspicion of post-obstructive diuresis and the unmasking of central diabetes insipidus.
authors.affiliation: Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Sasaki Yatabe
authors.forename: Kimio
authors.initials: K
authors.lastname: Watanabe
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Junichi
authors.initials: J
authors.lastname: Yatabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morimoto
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Ichihara
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakayama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D003919:Diabetes Insipidus / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D004231:Diuresis / Q000187:drug effects; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D000072659:Hypophysitis / Q000188:drug therapy / Q000503:physiopathology*; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011141:Polyuria / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology*; D051437:Renal Insufficiency / Q000188:drug therapy / Q000209:etiology*; D012185:Retroperitoneal Fibrosis / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G