Overlap of Post-obstructive Diuresis and Unmasked Diabetes Insipidus in a Case of IgG4-related Retroperitoneal Fibrosis and Tuberoinfundibular Hypophysitis: A Case Report and Review of the Literature
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- Sasaki Yatabe Midori
- Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
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- Watanabe Kimio
- Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
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- Hayashi Yoshimitsu
- Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
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- Yatabe Junichi
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
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- Morimoto Satoshi
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
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- Ichihara Atsuhiro
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
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- Nakayama Masaaki
- Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
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- Watanabe Tsuyoshi
- Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
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Abstract
<p>The clinical picture of IgG4-related disease (IgG4-RD) is diverse because various organs can be affected. We describe the case of a 56-year-old man with acute renal failure and tuberoinfundibular hypophysitis due to IgG4-RD. Steroid therapy lowered the serum IgG4 level and ameliorated renal dysfunction, bilateral hydronephrosis and retroperitoneal fibrosis. However, polyuria from post-obstructive diuresis and unmasked central diabetes insipidus ensued. The patient's polyuria continued despite the administration of a therapeutic dose of glucocorticoid; the patient's pituitary swelling and anterior pituitary dysfunction were partially ameliorated. The pituitary swelling recurred seven months later. In patients with IgG4-RD, the manifestation of polyuria after steroid therapy should prompt suspicion of post-obstructive diuresis and the unmasking of central diabetes insipidus. </p>
Journal
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- Internal Medicine
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Internal Medicine 56 (1), 47-53, 2017
The Japanese Society of Internal Medicine
