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04.01.2019 | Ausgabe 1/2019

Pituitary 1/2019

IgG4-related hypophysitis in patients with autoimmune pancreatitis

Zeitschrift:
Pituitary > Ausgabe 1/2019
Autoren:
Keitaro Kanie, Hironori Bando, Genzo Iguchi, Hideyuki Shiomi, Atsuhiro Masuda, Hidenori Fukuoka, Hitoshi Nishizawa, Yasunori Fujita, Arata Sakai, Takashi Kobayashi, Yuuki Shiomi, Kenichi Yoshida, Ryusaku Matsumoto, Kentaro Suda, Yuzo Kodama, Wataru Ogawa, Yutaka Takahashi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11102-018-00930-y) contains supplementary material, which is available to authorized users.
Keitaro Kanie and Hironori Bando have equally contributed to this work.

Abstract

Purpose

IgG4-related disease involves various organs including the pituitary and pancreas. The prevalence of IgG4-related hypophysitis is relatively rare compared with IgG4-related pancreatitis (autoimmune pancreatitis). Although several cases demonstrating both autoimmune pancreatitis and hypophysitis have been reported, the prevalence of IgG4-related hypophysitis in patients with autoimmune pancreatitis remains unknown. This study aimed at screening for IgG4-related hypophysitis to accurately determine its prevalence in patients with autoimmune pancreatitis.

Methods

In this cohort study, we screened IgG4-related hypophysitis via pituitary magnetic resonance imaging (MRI) and endocrinological examination in 27 patients who were undergoing follow-up for autoimmune pancreatitis at Kobe University Hospital between 2014 and 2018.

Results

Among 27 patients with autoimmune pancreatitis, 5 patients exhibited morphological abnormalities in the pituitary (18.5%). Among them, one patient (3.7%) met the criteria for hypophysitis with an enlarged pituitary and stalk concomitant with hypopituitarism. After glucocorticoid treatment, the enlarged pituitary shrank and became empty sella during the clinical course. Four patients (14.8%) revealed empty sella without obvious pituitary dysfunction. Four of 5 patients with morphological pituitary abnormalities showed multiple organ involvement in addition to pancreatic and pituitary involvement. Accordingly, multiple organ involvement was more prevalent in patients with morphological pituitary abnormalities (80%) compared to those without (48%).

Conclusions

Although a large-scale study is necessary to validate these results, these data suggest that the prevalence of hypophysitis in patients with autoimmune pancreatitis may be underestimated. Based on our findings, we recommend screening for hypophysitis, especially in patients with multiple organ involvement.

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