Overlap of Post-obstructive Diuresis and Unmasked Diabetes Insipidus in a Case of IgG4-related Retroperitoneal Fibrosis and Tuberoinfundibular Hypophysitis: A Case Report and Review of the Literature

• Published in: Internal Medicine Vol. 56; no. 1; pp. 47 - 53
• Main Authors: Yatabe, Midori Sasaki, Watanabe, Kimio, Hayashi, Yoshimitsu, Yatabe, Junichi, Morimoto, Satoshi, Ichihara, Atsuhiro, Nakayama, Masaaki, Watanabe, Tsuyoshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2017; Japan Science and Technology Agency
• Subjects: Case Report; Diabetes; Diabetes insipidus; Diabetes Insipidus - complications; Diabetes Insipidus - drug therapy; Diabetes Insipidus - physiopathology; Diuresis; Diuresis - drug effects; Fibrosis; Glucocorticoids - therapeutic use; Humans; Hypophysitis - drug therapy; Hypophysitis - physiopathology; IgG4-related disease; Immunoglobulin G; Immunoglobulin G - adverse effects; Immunoglobulin G - blood; Internal medicine; Literature reviews; Male; Middle Aged; Organs; pituitary; Pituitary (anterior); Polyuria; Polyuria - chemically induced; Polyuria - drug therapy; Polyuria - etiology; prednisolone; Renal failure; Renal function; Renal Insufficiency - drug therapy; Renal Insufficiency - etiology; retroperitoneal fibrosis; Retroperitoneal Fibrosis - physiopathology; Steroids; Treatment Outcome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.56.6648

The clinical picture of IgG4-related disease (IgG4-RD) is diverse because various organs can be affected. We describe the case of a 56-year-old man with acute renal failure and tuberoinfundibular hypophysitis due to IgG4-RD. Steroid therapy lowered the serum IgG4 level and ameliorated renal dysfunction, bilateral hydronephrosis and retroperitoneal fibrosis. However, polyuria from post-obstructive diuresis and unmasked central diabetes insipidus ensued. The patient's polyuria continued despite the administration of a therapeutic dose of glucocorticoid; the patient's pituitary swelling and anterior pituitary dysfunction were partially ameliorated. The pituitary swelling recurred seven months later. In patients with IgG4-RD, the manifestation of polyuria after steroid therapy should prompt suspicion of post-obstructive diuresis and the unmasking of central diabetes insipidus.