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01-02-2019 | Magnetic Resonance Imaging

IgG4-related hypophysitis in patients with autoimmune pancreatitis

Authors: 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

Published in: Pituitary | Issue 1/2019

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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Title: IgG4-related hypophysitis in patients with autoimmune pancreatitis
Authors: 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
Publication date: 01-02-2019
Publisher: Springer US
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
IgG4-Related Pancreatitis
Autoimmune Pancreatitis
Glucocorticoid
Hypopituitarism
Hypophysitis
Published in: Pituitary / Issue 1/2019
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-018-00930-y

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