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Case Reports
. 2015 Jul;19(3):273-6.
doi: 10.1055/s-0034-1397333. Epub 2015 Mar 5.

Thickened Pituitary Stalk Associated with a Mass in the Sphenoidal Sinus: An Alarm to Suspect Hypophysitis by Immunoglobulin G4?

Rafael Loch Batista  1 , Luciano Silva Ramos  1 , Valter Angelo Cescato  2 , Nina Rosa Castro Musolino  2 , Clarissa Groberio Borba  2 , Gilberto Ochman Silva  2 , Lilian Hupfeld Moreno  1 , Malebranche Bernardo Carneiro Cunha Neto  2
Affiliations
Case Reports

Thickened Pituitary Stalk Associated with a Mass in the Sphenoidal Sinus: An Alarm to Suspect Hypophysitis by Immunoglobulin G4?

Rafael Loch Batista et al. Int Arch Otorhinolaryngol. 2015 Jul.

Abstract

Introduction Hypophysitis is a chronic inflammation of the pituitary gland of complex and still incompletely defined pathogenesis. It belongs to the group of non-hormone-secreting sellar masses, sharing with them comparable clinical presentation and radiographic appearance. Objectives Describe the case of immunoglobulin G4 (IgG4)-related hypophysitis presenting as a mass in the sphenoid sinus. Resumed Report A 40-year-old Brazilian man had a diagnosis of central diabetes insipidus since 2001 associated with pituitary insufficiency. Pituitary magnetic resonance imaging revealed a centered pituitary stalk with focal nodular thickening and the presence of heterogeneous materials inside the sphenoid sinus. The patient was treated with testosterone replacement therapy. Laboratory results revealed increased IgG4 serum. Conclusion IgG4-related hypophysitis should be considered in patients with pituitary insufficiency associated with sellar mass and/or thickened pituitary stalk. IgG4 serum measurement for early diagnosis of IgG4-related hypophysitis should be performed.

Keywords: hypopituitarism; pituitary diseases; sphenoid sinus.

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Conflict of interest statement

Declaration of Interest Authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Fig. 1
Fig. 1
Magnetic resonance imaging showing thickening of the stalk and presence of heterogeneous materials inside sphenoid sinus. (A) T1-weighted coronal image without gadolinium. (B) T1-weighted coronal image with gadolinium.
See this image and copyright information in PMC

References

    1. Howlett T A, Levy M J, Robertson I J. How reliably can autoimmune hypophysitis be diagnosed without pituitary biopsy. Clin Endocrinol (Oxf) 2010;73(1):18–21. - PubMed
    1. Stone J H, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366(6):539–551. - PubMed
    1. Okazaki K, Umehara H. Are classification criteria for IgG4-RD now possible? The concept of IgG4-related disease and proposal of comprehensive diagnostic criteria in Japan. Int J Rheumatol. 2012;2012:357071. - PMC - PubMed
    1. van der Vliet H J, Perenboom R M. Multiple pseudotumors in IgG4-associated multifocal systemic fibrosis. Ann Intern Med. 2004;141(11):896–897. - PubMed
    1. Wong S, Lam W Y, Wong W K, Lee K C. Hypophysitis presented as inflammatory pseudotumor in immunoglobulin G4-related systemic disease. Hum Pathol. 2007;38(11):1720–1723. - PubMed

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