Occurrence of IgG4-related hypophysitis lacking IgG4-bearing plasma cell infiltration during steroid therapy.

Abstract

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.

• Authors: Yohsuke Ohkubo, Takashi Sekido, Keiko Takeshige, Hiroaki Ishi, Masahiro Takei, Shin-ichi Nishio, Masanori Yamazaki, Mitsuhisa Komatsu, Shigeyuki Kawa, Satoru Suzuki
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 53 Issue 7 Pg. 753-7 ( 2014) ISSN: 1349-7235 [Electronic] Japan
• PMID: 24694491 (Publication Type: Case Reports, Journal Article)

Chemical References

• Glucocorticoids
• Immunoglobulin G

Topics

• Aged
• Biopsy
• Diagnosis, Differential
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Hypothyroidism (drug therapy)
• Immunoglobulin G (blood, immunology)
• Magnetic Resonance Imaging
• Male
• Pituitary Diseases (blood, chemically induced, immunology)
• Pituitary Gland (drug effects, immunology, pathology)
• Plasma Cells (immunology, metabolism)