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Relapsed granulomatosis with polyangiitis with panhypopituitarism
Matthew J Triano1, William D Haberstroh2, Abhishek Lenka3
1Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA mjt92@georgetown.edu.
BMJ Case Reports
|January 29, 2021
Summary
Granulomatosis with polyangiitis (GPA) recurrence caused panhypopituitarism in a patient with long-term remission. Prompt treatment with glucocorticoids and methotrexate led to symptom resolution and pituitary function recovery.
Area of Science:
- Endocrinology
- Rheumatology
- Neurology
Background:
- Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis.
- Long-term remission of GPA is possible, but relapses can occur.
- GPA can affect multiple organ systems, including the pituitary gland.
Observation:
- A 60-year-old male with a history of GPA presented with fatigue and weight loss.
- Endocrinological tests revealed adrenal insufficiency, hypogonadism, hypothyroidism, and diabetes insipidus.
- Head MRI showed sinonasal inflammation extending into the pituitary gland.
Findings:
- The patient was diagnosed with panhypopituitarism secondary to recurrent GPA.
- Treatment with glucocorticoids and methotrexate improved pituitary function and resolved diabetes insipidus.
- Biopsy of sinonasal tissue was inconclusive.
Implications:
- Recurrent GPA can manifest as hypophysitis, leading to panhypopituitarism.
- Early diagnosis and multidisciplinary management are crucial for favorable outcomes.
- Lifelong hormone replacement therapy is necessary for patients with GPA-induced panhypopituitarism.
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