IgG4-related hypophysitis with subtle hypopituitarism in an elderly diabetic patient: Is treatment or observation preferable?

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Abstract

A 70-year-old man with diabetes mellitus presented with an enlarged pituitary stalk in 2014. IgG4-related parotitis and submandibular sialoadenitis were diagnosed in 2012. He denied any symptoms related to a pituitary mass. His visual field was intact, and his hypopituitarism was subtle. The serum IgG4 level was elevated. A lip biopsy revealed strong fibrosis and hyper-infiltration of IgG4-positive plasma cells. Based on these findings, IgG4-related hypophysitis was diagnosed. The patient was carefully followed without specific intervention. His clinical condition showed no change until December 2016, suggesting a stable, natural course. Care should be taken when considering glucocorticoid therapy, especially for elderly diabetic patients, given possible side effects.

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Kawasaki, M., Tsujino, M., Sato, F., Sakurada, M., Nishida, K., Kise, T., … Ogawa, Y. (2017). IgG4-related hypophysitis with subtle hypopituitarism in an elderly diabetic patient: Is treatment or observation preferable? Internal Medicine, 56(20), 2733–2738. https://doi.org/10.2169/internalmedicine.8851-17

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