Endocrine Abstracts

Introduction: Wegener granulomatosis is a necrotizing granulomatous small-vessel vasculitis. It typically affects the upper respiratory tract, lungs, and kidneys but can involve virtually any organ including the pituitary. Pituitary involvement in wegener granumatosis is rare.

Case: A 50-year-old woman was admitted to the hospital with severe dyspne for 2 years and stridor for a month. During her hospitalization, her sodium level was noted to be persistently high. A further workup revealed a consistently low urine osmolality in the presence of high serum osmolality suggesting partially diabetes insipidus. Her baseline laboratory data showed Na 164 mEq/l (135–145 mEq/l), serum osmolality 351 mOsm/kg (285–295 mOsm/kg), and urine osmolality 232 mOsm/kg. The results were consistent with partial CDI. Her serum sodium level was corrected with increased free water intake and did not require desmopressin. Anterior pituitary functions were normal at presentation. MRI revealed enlargement of the whole pituitary, including the stalk, with heterogeneous gadolinium enhancement and a disappearance of the high signal intensity of the posterior pituitary. (Figure 1). Computed tomography showed thickened mucosa of the nasal sinus and multiple small nodular lesions in the lung. A nasal sinus biopsy revealed a pauci-immune focal segmental necrotizing sinusitis. She was diagnosed with wegener granulomatosis. Serology revealed negative ANCA, and the C-reactive protein (CRP) was elevated. No abnormalities were noted upon urine examination. Intravenous pulse methylprednisolone 1000 mg was administered for 3 days and then cyclophosphamide was given at a dose 1000 mg monthly for 3 months. A repeat brain MRI 4 months later showed complete resolution (Figure 2).

Conclusion: We think that pituitary enlargement in wegener granulomatosis can disappear totally with immuno supressive agents in some patients.

Keywords: wegener granulomatosis, pituitary mass, immuno supressive agents