AI Article Synopsis
- A 46-year-old man experienced frontal headaches, visual field defects, and fatigue, leading to an MRI revealing an enlarged pituitary gland and a mass affecting the optic chiasm.
- Imaging also showed strong enhancement with dural involvement, while blood tests indicated decreased hormone levels and high anti-thyroglobulin antibodies, suggesting autoimmune thyroiditis.
- Treatment with intravenous prednisolone followed by a tapering oral dose resulted in recovery of symptoms and significant reduction of the pituitary mass on MRI, indicating the effectiveness of glucocorticoids for autoimmune hypophysitis.
Article Abstract
A 46-year-old man presented with frontal headache, a visual field defect and general fatigue. Magnetic resonance imaging (MRI) of the brain showed symmetrical enlargement of the pituitary gland and stalk due to the presence of a mass lesion extending toward the optic chiasm. Gadolinium injection further revealed homogeneous strong enhancement with involvement of the adjacent dura (dural tail). Basal plasma levels of ACTH, free thyroxine and gonadotropins were decreased, and 24-h urinary 17-OHCS excretion was reduced. An elevated anti-thyroglobulin antibody titer indicated the presence of autoimmune thyroiditis. Under the suspicion of autoimmune hypophysitis, 60 mg/day prednisolone sodium succinate was intravenously administered for two weeks followed by a decreasing dose of oral prednisolone. Clinical symptoms and pituitary dysfunction recovered during steroid treatment and MRI showed marked shrinkage of the pituitary mass. Early initiation of an intravenous dose of glucocorticoid followed by oral steroid administration therefore seems to be an efficient treatment for autoimmune hypophysitis even in patients with visual dysfunction.
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| http://dx.doi.org/10.2169/internalmedicine.45.1750 | DOI Listing |
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