Please use this identifier to cite or link to this item: https://ir.swu.ac.th/jspui/handle/123456789/13626
ชื่อเรื่อง: Clinical course of IgG4-related hypophysitis presenting with focal seizure and relapsing lymphocytic hypophysitis
ผู้แต่ง: Ngaosuwan K.
Trongwongsa T.
Shuangshoti S.
Keywords: acetylsalicylic acid
adenohypophysis hormone
immunoglobulin G4
levothyroxine
phenytoin
prednisolone
simvastatin
steroid
adenohypophysis hypofunction
adult
Article
brain biopsy
brain infarction
case report
differential diagnosis
drug dose reduction
drug megadose
focal epilepsy
frontal lobe
headache
hemianopia
histopathology
human
human tissue
hypophysitis
immunoglobulin blood level
immunoglobulin G4 related hypophysitis
low drug dose
lymphocytic hypophysitis
male
nuclear magnetic resonance imaging
pituitary incidentaloma
right hemisphere
visual impairment
autoimmune hypophysitis
complication
lymphocytosis
pathology
Pituitary Diseases
prognosis
Seizures
Adult
Autoimmune Hypophysitis
Humans
Lymphocytosis
Male
Pituitary Diseases
Prognosis
Seizures
Steroids
วันที่เผยแพร่: 2015
บทคัดย่อ: Background: This is the first case report of focal seizure as a manifestation of Immunoglobulin G4 (IgG4)-related hypophysitis. IgG4-related hypophysitis is a novel category of hypophysitis. The clinical presentations, imaging studies and initial pathology studies can mimic lymphocytic hypophysitis. Here we report additional clinical clues in differentiating these two conditions. Case presentation: A 43-year-old Thai male presented with focal seizure, headache, and anterior pituitary hypofunction. His MRI study showed typical hypophysitis lesion with abnormal cerebral parenchymal signal intensity at right frontal lobe. The pituitary biopsied was obtained and the patient was initially diagnosed with lymphocytic hypophysitis. Following initial low-dose steroid therapy, his seizure and headache resolved but his anterior pituitary hormones remained deficient. However, during steroid tapering, he developed new onset acute visual loss. Upon rigorous pathologic review, his diagnosis of IgG4-related hypophysitis with suspected CNS involvement was established. He was subsequently treated with high-dose steroid and rapidly regained his sight. Conclusion: This case report highlights the important distinguishing features of IgG4-related hypophysitis from lymphocytic hypophysitis. These include the relapsing clinical course of hypophysitis after steroid decrement and concomitant pachymeningitis particularly in middle-aged to elderly Asian male who presented with hypophysitis. With appropriate dosage of steroids, medical treatment is usually sufficient to control the disease and surgical interventions are usually not required. © 2015 Ngaosuwan et al.
URI: https://ir.swu.ac.th/jspui/handle/123456789/13626
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84945955517&doi=10.1186%2fs12902-015-0062-x&partnerID=40&md5=e64e73c96d49d194424a06edf15814b4
ISSN: 14726823
Appears in Collections:Scopus 1983-2021

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