Wegener’s granulomatosis complicated by central diabetes insipidus and peripheral neutrophy with normal pituitary in a patient

Xue, Jing; Wang, Huiying; Wu, Huaxiang; Jin, Qiaofei

doi:10.1007/s00296-008-0774-6

Cited by 20 publications

(12 citation statements)

References 13 publications

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“…Even though this could rarely be the presentation symptom (20), it generally appears more frequently with the progression of WG (16,18). Moreover, while pituitary participation may evolve with partial recovery and an adequate clinical response to systemic therapy (21), in most of the cases it has not been reported to improve without specific endocrine replacement therapy (6).…”

Section: Discussionmentioning

confidence: 99%

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Panhypopituitarism due to Wegener's granulomatosis

Santoro

Guida

Furioso

et al. 2011

Arq Bras Endocrinol Metab

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SUMMARYWegener's granulomatosis (WG) is a multi-system necrotizing granulomatous vasculitis which classically affects the upper respiratory tract, lungs and kidneys. Pituitary participation has been described in 24 patients in the literature to date. The aim of this article is to report a case of pituitary involvement in WG, and to present a literature review on this association. We present a female patient with WG who evolved with central diabetes insipidus (CDI), panhypopituitarism, and mild hyperprolactinemia. MRI showed an infiltrative pattern. Pituitary involvement has been reported in around 1% of patients with WG, mostly in women. It is represented by CDI and hypopituitarism. MRI generally shows pituitary enlargement, stalk thickening and loss of hyperintensity of the neurohypophysis. Permanent endocrine therapy is generally needed. WG should be considered in cases of CDI and hypopituitarism, essentially if a vasculitis is suspected and more common sellar disorders have been ruled out. Arq Bras Endocrinol Metab. 2011;55(7):481-5 SUMáRio A granulomatose de Wegener (GW) é uma vasculite necrotizante multissistêmica que afeta classicamente o trato respiratório superior, pulmões e rins. O envolvimento da hipófise foi descrita em 24 pacientes na literatura, até hoje. O objetivo deste artigo é relatar um caso de GW com envolvimento pituitário, e apresentar uma revisão da literatura sobre esta associação. Apresentamos uma paciente com GW que evoluiu para diabetes insipidus central (DIC), panhipopituitarismo e leve hiperprolactinemia. A RM mostrou um padrão infiltrativo. O envolvimento da hipó-fise foi relatado em cerca de 1% dos pacientes cm GW, na sua maioria mulheres. A desordem é representada por DIC e hipopituitarismo. A RM geralmente mostra o aumento da hipófise, aumento da espessura da haste, e perda da hiperintensidade da neurohipofise. Normalmente, é necessária terapia endócrina permanente. A GW é geralmente considerada nos casos de DIC e hipopituitarismo, essencialmente se há suspeita de vasculite e quando desordens selares mais comuns foram descartadas. Arq Bras Endocrinol Metab. 2011;55(7):481-5

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Section: Discussionmentioning

confidence: 99%

“…In relation to the clinical behavior of pituitary involvement in WG, as it was previously referred, it is mainly represented by any degree of CDI, combined with anterior hypopituitarism (17)(18)(19). Even though this could rarely be the presentation symptom (20), it generally appears more frequently with the progression of WG (16,18).…”

Section: Discussionmentioning

confidence: 99%

Panhypopituitarism due to Wegener's granulomatosis

Santoro

Guida

Furioso

et al. 2011

Arq Bras Endocrinol Metab

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“…According to the prior study, less than 1% of patients with GPA have pituitary involvements [10]. Central DI is the most common presentation in patients who have pituitary involvement, frequently with combined anterior hypopituitarism, which usually develops after pulmonary or kidney involvement [4,11]. Meanwhile, Düzgün et al [5] reported a case of a patient with GPA who presented with central DI early in the disease course before renal and pulmonary involvement.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Granulomatosis with Polyangiitis Presenting with Central Diabetes Insipidus

et al. 2015

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We report on a case of limited form of granulomatosis with polyangiitis (GPA) with pituitary involvement which presented with central diabetes insipidus. This rare form of GPA has not been reported in Korea. The patient presented with fever, headache, productive cough, nasal symptoms, and polyuria. Laboratory data and imaging studies demonstrated inflammatory lesions in nasal sinus and lungs. Pituitary stalk thickening and enhancement were observed on brain magnetic resonance imaging. The histopathology of the lung lesions showed chronic active granulomatous inflammation. Polyuria, hyperosmolar hypernatremia, and decreased urine osmolality which responded to synthetic vasopressin analog were consistent with central diabetes insipidus.

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“…The present case is unique in that the patient initially presented with RPGN. On the other hand, from the perspective of GPA, the incidence of central nervous system involvement with GPA has been reported in about 20% of cases, with HCP representing less than 1% of these 9,35) . We could not obtain a complete view of relationships between GPA and HCP, PR3 ANCA and HCP, because cases including full details of the clinical course were scarce.…”

Section: Discussionmentioning

confidence: 99%

Hypertrophic Cranial Pachymeningitis in Mpo-Anca-Related Vasculitis: A Case Report and Literature Review

Watanabe

Tani

Kimura

et al. 2013

FJMS

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: A 75 -year -old woman presented with rapidly progressive glomerulonephritis with positive results for anti -myeloperoxidase anti -neutrophil cytoplasmic antibody (MPO -ANCA). Corticosteroid therapy was successfully introduced. However, 7 months later, magnetic resonance imaging revealed marked swelling in the falx cerebri and high density regions were apparent on gallium scintigraphy, leading to diagnosis of hypertrophic cranial pachymeningitis (HCP). Symptoms improved with intensified corticosteroid therapy, but radiological examination 9 months later revealed right nasal sinus inflammation accompanied by osteolytic change. Granulomatosis with polyangiitis (Wegener's) was finally diagnosed. HCP is an important complication in MPO -ANCArelated vasculitis, and needs to be considered during the clinical course.

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Wegener’s granulomatosis complicated by central diabetes insipidus and peripheral neutrophy with normal pituitary in a patient

Cited by 20 publications

References 13 publications

Panhypopituitarism due to Wegener's granulomatosis

Panhypopituitarism due to Wegener's granulomatosis

Pituitary Granulomatosis with Polyangiitis Presenting with Central Diabetes Insipidus

Hypertrophic Cranial Pachymeningitis in Mpo-Anca-Related Vasculitis: A Case Report and Literature Review

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