Pituitary involvement in Wegener’s granulomatosis

Yong, Tuck Yean; Li, Jordan; ́Amato, Lisa D; Mahadevan, Kumar; Phillips, Patrick J.; Coates, Penelope; Coates, P. Toby

doi:10.1007/s11102-007-0021-2

Cited by 66 publications

(76 citation statements)

References 20 publications

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“…Final confirmation of the diagnosis is based on histological analysis (3,9). ment of other organs, especially the respiratory tract and kidneys, with only one case reported as isolated pituitary involvement (6).…”

Section: Discussionmentioning

confidence: 99%

“…Even though this could rarely be the presentation symptom (20), it generally appears more frequently with the progression of WG (16,18). Moreover, while pituitary participation may evolve with partial recovery and an adequate clinical response to systemic therapy (21), in most of the cases it has not been reported to improve without specific endocrine replacement therapy (6). Isolated CDI or anterior pituitary involvement has also been reported, though in a lesser extent (16,21).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the adenohypophysis can also exhibit loss of intensity (6). In other cases, a sellar mass or cyst has been described (24).…”

Section: Discussionmentioning

confidence: 99%

“…This scheme is justified by the fact that there would be nearly 50% lesser chance of relapse in patients treated with combination of cyclophosphamide and steroids, than with steroids alone (6). However, as it was already mentioned, the course of pituitary involvement in WG is generally not parallel to the one of the general disease, and only approximately 11% of the reported cases had full pituitary function recovery with systemic therapy (6).…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 24 cases of pituitary involvement in WG have been reported in the literature so far (6,7). The aim of this article is to describe a case of pituitary involvement in a patient with previous diagnose of WG, and to make a brief discussion of pituitary involvement in WG.…”

Section: Sumáriomentioning

confidence: 99%

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Panhypopituitarism due to Wegener's granulomatosis

Santoro

Guida

Furioso

et al. 2011

Arq Bras Endocrinol Metab

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SUMMARYWegener's granulomatosis (WG) is a multi-system necrotizing granulomatous vasculitis which classically affects the upper respiratory tract, lungs and kidneys. Pituitary participation has been described in 24 patients in the literature to date. The aim of this article is to report a case of pituitary involvement in WG, and to present a literature review on this association. We present a female patient with WG who evolved with central diabetes insipidus (CDI), panhypopituitarism, and mild hyperprolactinemia. MRI showed an infiltrative pattern. Pituitary involvement has been reported in around 1% of patients with WG, mostly in women. It is represented by CDI and hypopituitarism. MRI generally shows pituitary enlargement, stalk thickening and loss of hyperintensity of the neurohypophysis. Permanent endocrine therapy is generally needed. WG should be considered in cases of CDI and hypopituitarism, essentially if a vasculitis is suspected and more common sellar disorders have been ruled out. Arq Bras Endocrinol Metab. 2011;55(7):481-5 SUMáRio A granulomatose de Wegener (GW) é uma vasculite necrotizante multissistêmica que afeta classicamente o trato respiratório superior, pulmões e rins. O envolvimento da hipófise foi descrita em 24 pacientes na literatura, até hoje. O objetivo deste artigo é relatar um caso de GW com envolvimento pituitário, e apresentar uma revisão da literatura sobre esta associação. Apresentamos uma paciente com GW que evoluiu para diabetes insipidus central (DIC), panhipopituitarismo e leve hiperprolactinemia. A RM mostrou um padrão infiltrativo. O envolvimento da hipó-fise foi relatado em cerca de 1% dos pacientes cm GW, na sua maioria mulheres. A desordem é representada por DIC e hipopituitarismo. A RM geralmente mostra o aumento da hipófise, aumento da espessura da haste, e perda da hiperintensidade da neurohipofise. Normalmente, é necessária terapia endócrina permanente. A GW é geralmente considerada nos casos de DIC e hipopituitarismo, essencialmente se há suspeita de vasculite e quando desordens selares mais comuns foram descartadas. Arq Bras Endocrinol Metab. 2011;55(7):481-5

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In addition, the adenohypophysis can also exhibit loss of intensity (6). In other cases, a sellar mass or cyst has been described (24).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Sumáriomentioning

confidence: 99%

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Panhypopituitarism due to Wegener's granulomatosis

Santoro

Guida

Furioso

et al. 2011

Arq Bras Endocrinol Metab

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A 62‐Year‐Old Man With Progressive Weakness, Multiple Neurologic Deficits, and Hypernatremia

Lim

Chia

Lim

et al. 2013

Arthritis Care & Research

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A 62-year-old Chinese man was admitted for progressive weakness, loss of weight and appetite, and multiple neurologic deficits. History of the presenting symptomThe patient had a 6-month history of unsteady gait and generalized weakness with constitutional symptoms of loss of weight and appetite. He consulted his general practitioner 2 months later. Laboratory investigations then showed normal complete blood count and liver and thyroid function tests. Magnetic resonance imaging (MRI) of the brain with contrast fluid-attenuated inversion recovery (FLAIR) sequences and diffusion-weighted imaging showed multiple nonspecific foci of an abnormal signal seen in the white matter of both cerebral hemispheres. VDRL serology was nonreactive. The only abnormal investigation was an elevated serum sodium level at 148 mmoles/liter (reference interval 135-145). He was referred to a neurologist, who made a diagnosis of multiple system atrophy based on features of cerebellar dysfunction and dysautonomia, which included orthostatic hypotension and erectile dysfunction. His serum vitamin E level was 11.3 mg/liter (reference interval 5.5-18.0). He was commenced on highdose oral vitamin E therapy as an antioxidant for multiple system atrophy. He subsequently presented to the general medicine department and was admitted for progression of symptoms. Medical historyHe had been attending long-term followup visits with his general practitioner for hyperlipidemia and type 2 diabetes mellitus for Ͼ10 years. Glycosylated hemoglobin (HbA1c) 2 months prior to admission was 11.8%. His regular medications included lovastatin, glipizide, and vitamin E tablets. He had no recent exposure to anyone with tuberculosis or history of pulmonary tuberculosis. Medications and allergiesHe did not consume any over-the-counter medications or traditional herbal preparations. He was adherent to his medications, but not to dietary control for diabetes mellitus and hyperlipidemia. Social and family historyThe patient was born in Singapore and was the fourth of 10 children. There was a family history of hypertension and hyperlipidemia, but no history of neurologic disease or malignancy. His younger sister had died of an unknown complication of systemic lupus erythematosus (SLE) 2 decades before. He was single and living with his father. He was retired and used to work as a taxi driver. He did not smoke tobacco or consume any ethanol or illicit drugs. Review of systemsThe patient experienced a week's duration of change in bowel habit in the form of intermittent constipation. There was no per rectal bleeding, blood mixed with stools, chest pain, shortness of breath, abdominal pain, chronic cough, or any change in micturition. There was no history of joint pain, oral ulcers, alopecia, photosensitivity, Raynaud's phenomenon, or fever. Physical examinationExamination upon admission revealed a thin man who weighed 45 kg. He appeared lethargic, but was alert, coherent, nontoxic, and apyrexial. He was noted to have significant postural hypotension: his supine blood press...

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The optic chiasm

Kidd

2014

Clinical Anatomy

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The optic chiasm is formed when the optic nerves come together in order to allow for the crossing of fibers from the nasal retina to the optic tract on the other side. This enables vision from one side of both the eyes to be appreciated by the occipital cortex of the opposite side. This review makes note of the embryology, anatomy and vascular supply of the optic chiasm, then discusses the clinical syndromes associated with chiasmal disease, and the diseases which commonly influence its function.

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Pituitary involvement in Wegener’s granulomatosis

Cited by 66 publications

References 20 publications

Panhypopituitarism due to Wegener's granulomatosis

Panhypopituitarism due to Wegener's granulomatosis

A 62‐Year‐Old Man With Progressive Weakness, Multiple Neurologic Deficits, and Hypernatremia

The optic chiasm

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