IgG4-related hypophysitis in patients with autoimmune pancreatitis
IgG4-related hypophysitis in patients with autoimmune pancreatitis
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DOI：
10.1007/s11102-018-00930-y
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发表时间：
2019-01
期刊：
影响因子：
3.8
通讯作者：
Keitaro Kanie;H. Bando;G. Iguchi;H. Shiomi;A. Masuda;H. Fukuoka;H. Nishizawa;Y. Fujita;A. Sakai;Takashi Kobayashi;Y. Shiomi;Kenichi Yoshida;R. Matsumoto;Kentaro Suda;Y. Kodama;W. Ogawa;Yutaka Takahashi
中科院分区：
文献类型：
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作者：
Keitaro Kanie;H. Bando;G. Iguchi;H. Shiomi;A. Masuda;H. Fukuoka;H. Nishizawa;Y. Fujita;A. Sakai;Takashi Kobayashi;Y. Shiomi;Kenichi Yoshida;R. Matsumoto;Kentaro Suda;Y. Kodama;W. Ogawa;Yutaka Takahashi
目的IgG 4相关性疾病累及包括垂体和胰腺在内的多个器官。与IgG4相关胰腺炎（自身免疫性胰腺炎）相比，IgG4相关垂体炎的患病率相对罕见。虽然已经报道了几例同时表现出自身免疫性胰腺炎和垂体炎的病例，但自身免疫性胰腺炎患者中IgG 4相关垂体炎的患病率仍然未知。本研究旨在筛查IgG 4相关垂体炎，以准确确定其在自身免疫性胰腺炎患者中的患病率。我们通过垂体磁共振成像（MRI）和内分泌学检查对27例接受随访的患者进行了IgG 4相关垂体炎的筛查，结果27例自身免疫性胰腺炎患者中，5例（18.5%）垂体形态异常。其中，1例患者（3.7%）符合垂体炎的标准，伴有垂体和垂体柄增大伴垂体功能减退。经糖皮质激素治疗后，增大的垂体缩小，并在临床过程中成为空蝶鞍。空蝶鞍4例（14.8%），无明显垂体功能障碍。5例垂体形态异常患者中有4例除胰腺和垂体受累外，还表现为多器官受累。因此，多器官受累是更普遍的垂体形态异常的患者（80%）相比，那些没有（48%）。ConclusionsAlthough一个大规模的研究是必要的，以验证这些结果，这些数据表明，垂体炎的患病率在自身免疫性胰腺炎患者可能被低估。根据我们的研究结果，我们建议筛查垂体炎，特别是在多器官受累的患者。
PurposeIgG4-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.MethodsIn 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.ResultsAmong 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%).ConclusionsAlthough 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.