Occurrence of IgG4-related Hypophysitis Lacking IgG4-bearing Plasma Cell Infiltration during Steroid Therapy

• Published in: Internal Medicine Vol. 53; no. 7; pp. 753 - 757
• Main Authors: Ohkubo, Yohsuke, Sekido, Takashi, Takeshige, Keiko, Ishi, Hiroaki, Takei, Masahiro, Nishio, Shin-ichi, Yamazaki, Masanori, Komatsu, Mitsuhisa, Kawa, Shigeyuki, Suzuki, Satoru
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2014
• Subjects: Aged; Biopsy; Diagnosis, Differential; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humans; hypophysitis; Hypothyroidism - drug therapy; IgG4; Immunoglobulin G - blood; Immunoglobulin G - immunology; Magnetic Resonance Imaging; Male; pituitary; Pituitary Diseases - blood; Pituitary Diseases - chemically induced; Pituitary Diseases - immunology; Pituitary Gland - drug effects; Pituitary Gland - immunology; Pituitary Gland - pathology; Plasma Cells - immunology; Plasma Cells - metabolism
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.53.0714

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.