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
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 dysfunct...
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| Published in | Internal Medicine Vol. 56; no. 1; pp. 47 - 53 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
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01.01.2017
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| Abstract | 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. |
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| AbstractList | 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. |
| Author | Yatabe, Junichi Watanabe, Tsuyoshi Ichihara, Atsuhiro Nakayama, Masaaki Hayashi, Yoshimitsu Morimoto, Satoshi Yatabe, Midori Sasaki Watanabe, Kimio |
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| Cites_doi | 10.1016/S0140-6736(14)60720-0 10.1016/j.autrev.2014.08.013 10.1056/NEJM200103083441005 10.1507/endocrj.K09E-356 10.1155/2012/754935 10.3109/s10165-011-0508-6 10.1111/cei.12641 10.1136/annrheumdis-2014-206605 10.1155/2012/259408 10.2169/internalmedicine.53.0714 10.1530/EJE-13-0642 10.3748/wjg.v19.i1.35 10.1210/jc.2010-2970 10.1111/j.1464-410X.2012.11193.x 10.3109/s10165-011-0571-z 10.2169/internalmedicine.42.991 10.1507/endocrj.K09E-277 10.1016/j.humpath.2007.06.011 10.1507/endocrj.EJ13-0407 |
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| SubjectTerms | 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 |
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| Title | 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 |
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