Idiopathic Giant Cell Granulomatous Hypophysitis with Hypopituitarism, Right Abducens Nerve Paresis and Masked Diabetes Insipidus

Tohru Fujiwara, Kozo Ota, Noriko Kakudo, Shozo Rikimaru, Tomohiro Sugawara, Katsura Yamada, Tatsuyuki Satoh, Mitsushi Yano, Eiichi Tamate, Masaetsu Miura, Hidetoshi Ikeda, Tokihisa Kimura

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

A 38-year-old man presented with headache, fever, and double vision associated with right abducens nerve paresis. He had neither nuchal rigidity nor visual field defect. Laboratory data revealed elevated erythrocyte sedimentation rate (ESR), eosinophilia, and lymphocytic pleocytosis in the cerebrospinal fluid (CSF). Provocation tests of pituitary hormones showed partial hypopituitarism. Magnetic resonance imaging (MRI) revealed swelling of the hypophysis and a mass lesion expanding into the right cavernous sinus. The supplement dose of dexamethasone for hypothalamic hypocortisolism manifested diabetes insipidus. Biopsy, carried out through the transsphenoidal approach, revealed giant cell granuloma. Systemic granulomatous diseases were ruled out, and the lesion was considered to be idiopathic giant cell granulomatous hypophysitis. Right abducens nerve paresis, diabetes insipidus and dysfunction of the anterior lobe were amended by the treatment with prednisolone for 4 months, and findings of the pituitary gland and stalk were normalized. The present case shows that glucocorticoid has an effect on amendment of idiopathic giant cell granulomatous hypophysitis.

Original languageEnglish
Pages (from-to)915-919
Number of pages5
JournalInternal Medicine
Volume40
Issue number9
DOIs
Publication statusPublished - 2001

Keywords

  • Hypothalamic hypocortisolism
  • Magnetic resonance imaging
  • Prednisolone
  • Transsphenoidal biopsy

ASJC Scopus subject areas

  • Internal Medicine

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