A case series of atypical features of patients with biopsy-proven isolated IgG4-related hypophysitis and normal serum IgG4 levels
AuthorYuen, Kevin C. J.
Moloney, Kelley J.
Mercado, Jennifer U.
McCullough, Brendan J.
Litvack, Zachary N.
Delashaw, Johnny B.
Mayberg, Marc R.
AffiliationUniv Arizona, Coll Med, Dept Neuroendocrinol
Univ Arizona, Coll Med, Dept Neurosurg
MetadataShow full item record
CitationYuen, K.C.J., Moloney, K.J., Mercado, J.U. et al. Pituitary (2018) 21: 238. https://doi.org/10.1007/s11102-017-0852-4
Rights© Springer Science+Business Media, LLC, part of Springer Nature 2017
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractBackground IgG4-related hypophysitis is a rare clinical entity that forms part of an emerging group of multi-organ IgG4-related fibrosclerotic systemic diseases. The rare prevalence of the disease, presenting features that overlap with other sellar pathologies, and variable imaging features can make preoperative identification challenging. Purpose and methods We report three cases of isolated IgG4-related hypophysitis with atypical clinical and imaging features that mimicked those of pituitary apoplexy and other sellar lesions. Additionally, we review the literature of IgG4-related hypophysitis to provide context for individual patient data described herein. Results All patients presented with symptoms that mimicked those of pituitary apoplexy and visual disturbance, and MRI findings suggestive of pituitary macroadenoma, Rathke's cleft cyst and craniopharyngioma. The clinical presentation warranted surgical decompression, resulting in rapid symptomatic improvement. Preoperative high-dose followed by postoperative low-dose glucocorticoid replacement therapy was administered in all cases. Histopathology showed dense infiltrate of IgG4 cells. Post-operative follow-up monitoring for 12-26 months revealed normal serum IgG4 levels with no other organ involvement, while endocrinological testing revealed persistent pituitary hormone deficiencies. Conclusions Our cases highlight the importance of considering IgG4-related hypophysitis in the differential diagnosis of solid and cystic sellar lesions presenting acutely with pituitary apoplexy symptoms. Existing diagnostic criteria may not be sufficiently precise to permit rapid and reliable identification, or avoidance of surgery in the acute setting. In contrast to other reports of the natural history of this condition, despite the severity of presenting features, the disease in our cases was pituitary-restricted with normal serum IgG4 levels.
Note12 month embargo; published online: 16 December 2017
VersionFinal accepted manuscript
- Clinical Interrogation for Unveiling an Isolated Hypophysitis Mimicking Pituitary Adenoma.
- Authors: Lee S, Choi JH, Kim CJ, Kim JH
- Issue date: 2017 Mar
- Critical review of IgG4-related hypophysitis.
- Authors: Shikuma J, Kan K, Ito R, Hara K, Sakai H, Miwa T, Kanazawa A, Odawara M
- Issue date: 2017 Apr
- [Hypophysitis : Types and differential diagnosis].
- Authors: Saeger W
- Issue date: 2016 May
- Rituximab was used to treat recurrent IgG4-related hypophysitis with ophthalmopathy as the initial presentation: A case report and literature review.
- Authors: Gu WJ, Zhang Q, Zhu J, Li J, Wei SH, Mu YM
- Issue date: 2017 Jun
- Lymphocytic Hypophysitis Secondary to Ruptured Rathke Cleft Cyst: Case Report and Literature Review.
- Authors: Yang C, Wu H, Bao X, Wang R
- Issue date: 2018 Jun