Autoimmune hypophysitis presenting with intracranial multi-organ involvement: three case reports and review of the literature

BMC Research Notes

Teiji Tominaga¹  Toshihiro Kumabe¹  Mika Watanabe²  Yoshikazu Ogawa³  Atsushi Kanoke³ 

[1] Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan;Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan;Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai 982-8523, Miyagi, Japan

关键词: Steroid pulse therapy;    Severe internal carotid artery stenosis;    Immunoglobulin G4-related disease;    Hypothalamus;    Hypophysitis;   

Others  :  1135079
DOI  :  10.1186/1756-0500-6-560

 received in 2013-10-07, accepted in 2013-12-16,  发布年份 2013

【 摘 要 】

Background

Autoimmune hypophysitis very rarely spreads to nearby organs outside the pituitary tissue, for unknown reasons, with only 5 reported cases of hypophysitis spreading over the cavernous sinus.

Case presentation

Three patients presented with cases of non-infectious hypophysitis spreading outside the pituitary tissue over the cavernous sinus. All three cases were diagnosed with histological confirmation by transsphenoidal surgery, and the patients showed remarkable improvement with postoperative pulse dose steroid therapy, including disappearance of abnormal signal intensities in the bilateral hypothalami on magnetic resonance imaging, resolution of severe stenosis of the internal carotid artery, and normalization of swollen pituitary tissues. Two of 3 cases fulfilled the histological criteria of immunoglobulin G4-related disease, although none of the patients had high serum immunoglobulin G4 level.

Conclusion

The true implications of such unusual spreading of hypophysitis to nearby organs are not fully understood, but the mechanism of occurrence might vary according to the timing of inflammation in this unusual mode of spreading. Pulse dose steroid therapy achieved remarkably good outcomes even in the patient with progressive severe stenosis of the internal carotid artery and rapid visual deterioration.

【 授权许可】

   
2013 Kanoke et al.; licensee BioMed Central Ltd.

【 图 表 】

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