Hypophysitis Presenting With Atypical Rapid Deterioration: With Special Reference to Immunoglobulin G4-Related Disease: Case Report
Primary hypophysitis is believed to be a chronic inflammation of the pituitary tissue caused by the autoimmune mechanism. The disease can be classified based on morphology and histology simultaneously, but the relationships between these subtypes remain unclarified. Moreover, hypophysitis may occur...
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| Veröffentlicht in: | Neurologia medico-chirurgica 2009, Vol.49(12), pp.622-625 |
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| container_title | Neurologia medico-chirurgica |
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| creator | OSAWA, Shinichiro OGAWA, Yoshikazu WATANABE, Mika TOMINAGA, Teiji |
| description | Primary hypophysitis is believed to be a chronic inflammation of the pituitary tissue caused by the autoimmune mechanism. The disease can be classified based on morphology and histology simultaneously, but the relationships between these subtypes remain unclarified. Moreover, hypophysitis may occur as a part of systemic immunoglobulin G4 (IgG4)-related plasmacytic disease. A 74-year-old woman was initially diagnosed with infundibulo-hypophysitis. After a long period of stability, she suffered rapid deterioration with evolving endocrinopathies and visual symptoms. Biopsy specimen established the diagnosis as granulomatous hypophysitis with positive reaction for IgG4 in infiltrating plasma cells. Postoperative glucocorticoid administration improved her condition dramatically. This case illustrates two interesting points: The rapid deterioration after a long stable clinical course, and the presence of IgG4-positive tissue in the pituitary gland, which can be considered as “primary” hypophysitis with no systemic IgG4-related disease in other organs. |
| doi_str_mv | 10.2176/nmc.49.622 |
| format | Article |
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The disease can be classified based on morphology and histology simultaneously, but the relationships between these subtypes remain unclarified. Moreover, hypophysitis may occur as a part of systemic immunoglobulin G4 (IgG4)-related plasmacytic disease. A 74-year-old woman was initially diagnosed with infundibulo-hypophysitis. After a long period of stability, she suffered rapid deterioration with evolving endocrinopathies and visual symptoms. Biopsy specimen established the diagnosis as granulomatous hypophysitis with positive reaction for IgG4 in infiltrating plasma cells. Postoperative glucocorticoid administration improved her condition dramatically. This case illustrates two interesting points: The rapid deterioration after a long stable clinical course, and the presence of IgG4-positive tissue in the pituitary gland, which can be considered as “primary” hypophysitis with no systemic IgG4-related disease in other organs.</description><identifier>ISSN: 0470-8105</identifier><identifier>EISSN: 1349-8029</identifier><identifier>DOI: 10.2176/nmc.49.622</identifier><identifier>PMID: 20035143</identifier><language>eng</language><publisher>Japan: The Japan Neurosurgical Society</publisher><subject>Acute Disease ; Aged ; Anti-Inflammatory Agents - therapeutic use ; Biomarkers ; Biopsy ; Diagnosis, Differential ; Disease Progression ; Encephalitis - drug therapy ; Encephalitis - immunology ; Encephalitis - pathology ; Endocrine System Diseases - immunology ; Endocrine System Diseases - pathology ; Endocrine System Diseases - physiopathology ; Female ; Glucocorticoids - therapeutic use ; granulomatous hypophysitis ; Humans ; Immunoglobulin G - analysis ; Immunoglobulin G - metabolism ; immunoglobulin G4 ; Pituitary Diseases - drug therapy ; Pituitary Diseases - immunology ; Pituitary Diseases - pathology ; Pituitary Gland - pathology ; Pituitary Gland - physiopathology ; Plasma Cells - pathology ; rapid deterioration ; systemic immunoglobulin G4-related plasmacytic disease ; Time Factors ; Treatment Outcome ; Vision, Low - etiology</subject><ispartof>Neurologia medico-chirurgica, 2009, Vol.49(12), pp.622-625</ispartof><rights>2009 by The Japan Neurosurgical Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-b090a57183bccdede2f10556599db3d6330bd74b823edd47422a72acf3879eb53</citedby><cites>FETCH-LOGICAL-c502t-b090a57183bccdede2f10556599db3d6330bd74b823edd47422a72acf3879eb53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,1877,4010,27902,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20035143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>OSAWA, Shinichiro</creatorcontrib><creatorcontrib>OGAWA, Yoshikazu</creatorcontrib><creatorcontrib>WATANABE, Mika</creatorcontrib><creatorcontrib>TOMINAGA, Teiji</creatorcontrib><title>Hypophysitis Presenting With Atypical Rapid Deterioration: With Special Reference to Immunoglobulin G4-Related Disease: Case Report</title><title>Neurologia medico-chirurgica</title><addtitle>Neurol. Med. Chir.(Tokyo)</addtitle><description>Primary hypophysitis is believed to be a chronic inflammation of the pituitary tissue caused by the autoimmune mechanism. The disease can be classified based on morphology and histology simultaneously, but the relationships between these subtypes remain unclarified. Moreover, hypophysitis may occur as a part of systemic immunoglobulin G4 (IgG4)-related plasmacytic disease. A 74-year-old woman was initially diagnosed with infundibulo-hypophysitis. After a long period of stability, she suffered rapid deterioration with evolving endocrinopathies and visual symptoms. Biopsy specimen established the diagnosis as granulomatous hypophysitis with positive reaction for IgG4 in infiltrating plasma cells. Postoperative glucocorticoid administration improved her condition dramatically. This case illustrates two interesting points: The rapid deterioration after a long stable clinical course, and the presence of IgG4-positive tissue in the pituitary gland, which can be considered as “primary” hypophysitis with no systemic IgG4-related disease in other organs.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Biomarkers</subject><subject>Biopsy</subject><subject>Diagnosis, Differential</subject><subject>Disease Progression</subject><subject>Encephalitis - drug therapy</subject><subject>Encephalitis - immunology</subject><subject>Encephalitis - pathology</subject><subject>Endocrine System Diseases - immunology</subject><subject>Endocrine System Diseases - pathology</subject><subject>Endocrine System Diseases - physiopathology</subject><subject>Female</subject><subject>Glucocorticoids - therapeutic use</subject><subject>granulomatous hypophysitis</subject><subject>Humans</subject><subject>Immunoglobulin G - analysis</subject><subject>Immunoglobulin G - metabolism</subject><subject>immunoglobulin G4</subject><subject>Pituitary Diseases - drug therapy</subject><subject>Pituitary Diseases - immunology</subject><subject>Pituitary Diseases - pathology</subject><subject>Pituitary Gland - pathology</subject><subject>Pituitary Gland - physiopathology</subject><subject>Plasma Cells - pathology</subject><subject>rapid deterioration</subject><subject>systemic immunoglobulin G4-related plasmacytic disease</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vision, Low - etiology</subject><issn>0470-8105</issn><issn>1349-8029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kE1Lw0AQQBdRbKm9-AMkZyF1s7v58laqtoWCUhWPYT8m7UqyCbtbIf_elLS9zBzm8WAeQvcRnpEoTZ5MLWcsnyWEXKFxRFkeZpjk12iMWYrDLMLxCE2d0wJjwjJGs_QWjQjGNI4YHaO_Vdc27b5z2msXfFhwYLw2u-BH-30w912rJa-CLW-1Cl7Ag9WN5V435nlAPluQ-khACRaMhMA3wbquD6bZVY04VNoESxZuoeIeeoV2wB3coZuSVw6mpz1B32-vX4tVuHlfrhfzTShjTHwocI55nEYZFVIqUEDK_qE4ifNcCaoSSrFQKRMZoaAUSxkhPCVclv2bOYiYTtDj4JW2cc5CWbRW19x2RYSLY7-i71ewvOj79fDDALcHUYO6oOdaPTAfgF_n-Q4uALdeywrOroicZi-93OSe2wIM_Qd3M4SY</recordid><startdate>2009</startdate><enddate>2009</enddate><creator>OSAWA, Shinichiro</creator><creator>OGAWA, Yoshikazu</creator><creator>WATANABE, Mika</creator><creator>TOMINAGA, Teiji</creator><general>The Japan Neurosurgical Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>2009</creationdate><title>Hypophysitis Presenting With Atypical Rapid Deterioration: With Special Reference to Immunoglobulin G4-Related Disease</title><author>OSAWA, Shinichiro ; OGAWA, Yoshikazu ; WATANABE, Mika ; TOMINAGA, Teiji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-b090a57183bccdede2f10556599db3d6330bd74b823edd47422a72acf3879eb53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Anti-Inflammatory Agents - therapeutic use</topic><topic>Biomarkers</topic><topic>Biopsy</topic><topic>Diagnosis, Differential</topic><topic>Disease Progression</topic><topic>Encephalitis - drug therapy</topic><topic>Encephalitis - immunology</topic><topic>Encephalitis - pathology</topic><topic>Endocrine System Diseases - immunology</topic><topic>Endocrine System Diseases - pathology</topic><topic>Endocrine System Diseases - physiopathology</topic><topic>Female</topic><topic>Glucocorticoids - therapeutic use</topic><topic>granulomatous hypophysitis</topic><topic>Humans</topic><topic>Immunoglobulin G - analysis</topic><topic>Immunoglobulin G - metabolism</topic><topic>immunoglobulin G4</topic><topic>Pituitary Diseases - drug therapy</topic><topic>Pituitary Diseases - immunology</topic><topic>Pituitary Diseases - pathology</topic><topic>Pituitary Gland - pathology</topic><topic>Pituitary Gland - physiopathology</topic><topic>Plasma Cells - pathology</topic><topic>rapid deterioration</topic><topic>systemic immunoglobulin G4-related plasmacytic disease</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vision, Low - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>OSAWA, Shinichiro</creatorcontrib><creatorcontrib>OGAWA, Yoshikazu</creatorcontrib><creatorcontrib>WATANABE, Mika</creatorcontrib><creatorcontrib>TOMINAGA, Teiji</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Neurologia medico-chirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>OSAWA, Shinichiro</au><au>OGAWA, Yoshikazu</au><au>WATANABE, Mika</au><au>TOMINAGA, Teiji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypophysitis Presenting With Atypical Rapid Deterioration: With Special Reference to Immunoglobulin G4-Related Disease: Case Report</atitle><jtitle>Neurologia medico-chirurgica</jtitle><addtitle>Neurol. Med. Chir.(Tokyo)</addtitle><date>2009</date><risdate>2009</risdate><volume>49</volume><issue>12</issue><spage>622</spage><epage>625</epage><pages>622-625</pages><issn>0470-8105</issn><eissn>1349-8029</eissn><abstract>Primary hypophysitis is believed to be a chronic inflammation of the pituitary tissue caused by the autoimmune mechanism. The disease can be classified based on morphology and histology simultaneously, but the relationships between these subtypes remain unclarified. Moreover, hypophysitis may occur as a part of systemic immunoglobulin G4 (IgG4)-related plasmacytic disease. A 74-year-old woman was initially diagnosed with infundibulo-hypophysitis. After a long period of stability, she suffered rapid deterioration with evolving endocrinopathies and visual symptoms. Biopsy specimen established the diagnosis as granulomatous hypophysitis with positive reaction for IgG4 in infiltrating plasma cells. Postoperative glucocorticoid administration improved her condition dramatically. This case illustrates two interesting points: The rapid deterioration after a long stable clinical course, and the presence of IgG4-positive tissue in the pituitary gland, which can be considered as “primary” hypophysitis with no systemic IgG4-related disease in other organs.</abstract><cop>Japan</cop><pub>The Japan Neurosurgical Society</pub><pmid>20035143</pmid><doi>10.2176/nmc.49.622</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | J-STAGE Free; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Disease Aged Anti-Inflammatory Agents - therapeutic use Biomarkers Biopsy Diagnosis, Differential Disease Progression Encephalitis - drug therapy Encephalitis - immunology Encephalitis - pathology Endocrine System Diseases - immunology Endocrine System Diseases - pathology Endocrine System Diseases - physiopathology Female Glucocorticoids - therapeutic use granulomatous hypophysitis Humans Immunoglobulin G - analysis Immunoglobulin G - metabolism immunoglobulin G4 Pituitary Diseases - drug therapy Pituitary Diseases - immunology Pituitary Diseases - pathology Pituitary Gland - pathology Pituitary Gland - physiopathology Plasma Cells - pathology rapid deterioration systemic immunoglobulin G4-related plasmacytic disease Time Factors Treatment Outcome Vision, Low - etiology |
| title | Hypophysitis Presenting With Atypical Rapid Deterioration: With Special Reference to Immunoglobulin G4-Related Disease: Case Report |
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