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Diagnosis and Treatment > Signs and Symptoms

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Takatoshi Anno Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Fumiko Kawasaki Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Maiko Takai Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Ryo Shigemoto Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Yuki Kan Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Hideaki Kaneto Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan

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Tomoatsu Mune Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan

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Kohei Kaku Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Niro Okimoto Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan

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Summary

A 76-year-old man had a hypopituitarism including adrenal insufficiency, hypogonadism and hypothyroidism. Based on various findings including the swelling of the pituitary gland, increase of serum IgG4 level and abundant IgG4-positive plasma cell infiltration in immunostaining of the pituitary gland, we diagnosed this subject as IgG4-related hypophysitis. In general, a high-dose glucocorticoid treatment is effective for IgG4-related disease. His clinical symptom, laboratory data and adrenal insufficiency were almost improved without any therapy. The serum IgG4 level was decreased and pituitary size was normalized with hydrocortisone as physiological replacement. This case report provides the possibility that IgG4 level is decreased spontaneously or with physiological dose of glucocorticoid therapy.

Learning points:

  • We performed the pituitary gland biopsy and histochemical examination glucocorticoid therapy in a subject with IgG4-related hypophysitis.

  • This case report provides the possibility that IgG4 level is decreased spontaneously or with a physiological dose of glucocorticoid therapy. We reported the clinical course of IgG4-related hypophysitis without a high-dose glucocorticoid treatment, although there were a few reports about the retrospective examination.

  • Although the patient had still higher IgG4 level compared to normal range, his clinical symptom disappeared and his laboratory data were improved.

  • We should keep in mind the possibility of IgG4-related hypophysitis when we examine one of the uncertain causes of a hypopituitarism including adrenal insufficiency, hypogonadism and hypothyroidism.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, ACTH, Antidiuretic Hormone, Cortisol, FSH, GH, IGF1, LH, Testosterone, TSH, Condition/ Syndrome, Adrenal insufficiency, Autoimmune hypophysitis, Hypogonadism, Hypophysitis, Hypothyroidism, IgG4–related systemic disease, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, Asian - Japanese, Diagnosis and Treatment, Signs and Symptoms, Appetite reduction/loss, Eosinophilia, Fatigue, Hypogonadism, Hyponatraemia, Hypopituitarism, Hypothyroidism, Investigation, ACTH, Biopsy, Corticotropin-releasing hormone stimulation test, Cortisol, FSH, FT4, GH, Glucose (blood, fasting), IGF1, Immunoglobulins, Immunoglobulin G4, LH, MRI, Prolactin, Serum osmolality, Testosterone, Thyroid function, TRH stimulation, TSH, Urine 24-hour volume, Urine osmolality, Medication, Glucocorticoids, Hydrocortisone, Levothyroxine, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-16-0148
Volume/Issue:
Volume 2017: Issue 1
Open access