In the Journals Plus

Pituitary abnormalities 'underestimated' in adults with autoimmune pancreatitis

Show Citation

February 22, 2019

Adults with autoimmune pancreatitis may have higher rates of immunoglobulin G4-related hypophysitis than previously thought, according to findings published in Pituitary.

“IgG4-related hypophysitis presents with various degrees of hypopituitarism and diabetes insipidus with a thickened pituitary stalk and/or pituitary mass,” Yutaka Takahashi, MD, PhD, associate professor in the division of diabetes and endocrinology of the department of internal medicine at Kobe University Graduate School of Medicine in Japan, and colleagues wrote. “Although the clinical symptoms of hypopituitarism are usually nonspecific, it is important that hypopituitarism is accurately diagnosed as it can potentially lead to increased mortality because of adrenal crisis.”

Takahashi and colleagues conducted a cohort study of 27 adults with type 1 autoimmune pancreatitis (18.5% women; mean age at screening, 68.6 years). Participants underwent MRI to determine IgG4-related hypophysitis status and were screened for hypopituitarism, pituitary function and serum IgG4 levels at Kobe University Hospital between 2014 and 2018.

There were 13 reported cases of other organ involvement in the cohort in relation to autoimmune pancreatitis while pituitary abnormalities were identified in five participants via MRI. Hypophysitis with hypopituitarism was identified in one of these participants. The other four had empty sella, which “is frequently observed in the late stage of hypophysitis,” the researchers wrote. The rate of multiple organ involvement among participants with pituitary abnormalities was 80%, which was higher than the 41% reported in participants without pituitary abnormalities.

“Our data suggest that the involvement of the pituitary gland in patients with autoimmune pancreatitis may be underestimated,” the researchers wrote. “In this study, we demonstrated that patients with multiple organ involvement, including autoimmune pancreatitis, have a higher incidence of hypophysitis. Thus, we recommended evaluation of pituitary and peripheral hormone levels in patients with multiple organ involvement.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

itj+ Infographic

itj+ Perspective