Anno Takatoshi, Kawasaki Fumiko, Takai Maiko, Shigemoto Ryo, Kan Yuki, Kaneto Hideaki, Mune Tomoatsu, Kaku Kohei, Okimoto Niro
Department of General Internal Medicine 1, Kawasaki Medical School, OkayamaJapan.
Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, KurashikiJapan.
Endocrinol Diabetes Metab Case Rep. 2017 Apr 28;2017. doi: 10.1530/EDM-16-0148. eCollection 2017.
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.
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.
一名76岁男性患有垂体功能减退症，包括肾上腺功能不全、性腺功能减退和甲状腺功能减退。基于包括垂体肿大、血清IgG4水平升高以及垂体免疫染色中大量IgG4阳性浆细胞浸润等各种发现，我们将该患者诊断为IgG4相关性垂体炎。一般来说，高剂量糖皮质激素治疗对IgG4相关性疾病有效。他的临床症状、实验室数据及肾上腺功能不全在未进行任何治疗的情况下几乎都有所改善。氢化可的松作为生理替代治疗后，血清IgG4水平下降，垂体大小恢复正常。本病例报告提示IgG4水平可能会自发下降或在生理剂量糖皮质激素治疗后下降。
我们对一名IgG4相关性垂体炎患者进行了垂体活检和糖皮质激素治疗的组织化学检查。本病例报告提示IgG4水平可能会自发下降或在生理剂量糖皮质激素治疗后下降。尽管有一些关于回顾性检查的报道，但我们报告了一例未接受高剂量糖皮质激素治疗的IgG4相关性垂体炎的临床过程。尽管该患者的IgG4水平仍高于正常范围，但其临床症状消失，实验室数据得到改善。当我们检查垂体功能减退症（包括肾上腺功能不全、性腺功能减退和甲状腺功能减退）的不确定病因之一时，应牢记IgG4相关性垂体炎的可能性。
