Relapsed granulomatosis with polyangiitis with panhypopituitarism.
| Autor: | Triano MJ; Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA mjt92@georgetown.edu., Haberstroh WD; Division of General Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA., Lenka A; Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA., Whelton SA; Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA.; Division of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA. |
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| Jazyk: | angličtina |
| Zdroj: | BMJ case reports [BMJ Case Rep] 2021 Jan 28; Vol. 14 (1). Date of Electronic Publication: 2021 Jan 28. |
| DOI: | 10.1136/bcr-2020-237774 |
| Abstrakt: | A man in his early 60s with a medical history of granulomatosis with polyangiitis (GPA) in remission for two decades without maintenance therapy presented with non-specific complaints of profound fatigue and 40-pound weight loss. He was seronegative for antinuclear antibodies and cytoplasmic antineutrophilic antibodies, but erythrocyte sedimentation rate and C reactive protein levels were elevated. Endocrinological testing revealed adrenal insufficiency, hypogonadism, hypothyroidism and diabetes insipidus. An MRI of the head revealed extensive sinonasal inflammation eroding through the floor of the sella turcica and into the pituitary gland and stalk. Biopsy of the sinonasal tissues was inconclusive. On review of his case, a multidisciplinary team diagnosed him with panhypopituitarism secondary to a recurrence of GPA. He responded well to glucocorticoids and methotrexate with marked reduction of pituitary enhancement on imaging and resolution of diabetes insipidus. He will require lifelong testosterone, levothyroxine and glucocorticoids for hormone replacement therapy. Competing Interests: Competing interests: None declared. (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.) |
| Databáze: | MEDLINE |
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