-
Medical journals
- Career
Granulomatosis with polyangiitis manifested as diabetes insipidus
Authors: Ondřej Pátek 1; Miroslava Horáčková 1; Lenka Vítová 1; Rudolf Horváth 2; Jaromír Háček 3; Otto Schück 1
Authors‘ workplace: Interní klinika 2. LF UK a FN v Motole, Praha 1; Oddělení revmatologie dětí a dospělých FN v Motole, Praha 2; Ústav patologie a molekulární medicíny 2. LF UK a FN v Motole, Praha 3
Published in: Vnitř Lék 2016; 62(7-8): 679-683
Category: Case Reports
Overview
The case report shows a surprising presentation of pulmonary granulomatosis with polyangiitis (GPA) through symptoms of diabetes insipidus (DI) with granulomatous infiltration of the pituitary gland. The pituitary hormonal dysfunction as a result of granulomatosis of the pituitary gland is rare. Several studies have demonstrated that the incidence of the pituitary dysfunction reaches approx. 1 % of the patients with GPA. However it is mostly presented in patients with the disease already diagnosed. The patient described by us had no clinical expressions of GPA in the respiratory tract. He presented with polyuria and polydipsia. It was not until a more detailed examination of these symptoms was performed that a focal lung disease was detected and diagnosed as GPA.
Key words:
diabetes insipidus – granulomatosis with polyangiitis – granulomatous infiltration of the pituitary gland – pituitary hormonal dysfunction
Sources
1. Sampei S, Watanabe R, Ishii T et al. Granulomatosis with polyangiitis preceded by central diabetes insipidus. Intern Med 2014; 53(15): 1725–1726.
2. Slabu H, Arnason T. Pituitary granulomatosis with polyangiitis. BMJ Case Rep 2013; 2013. pii: bcr2013008656. Dostupné z DOI: <http://dx.doi.org/10.1136/bcr-2013–008656>.
3. Ball GV, Bridges SL. Vasculitis. Oxford University Press: Oxford 2002. ISBN 978–0192630537.
4. De Parisot A, Puéchal X, Langrand C et al. Pituitary involvement in granulomatosis with polyangiitis: report of 9 patients and review of the literature. Medicine (Baltimore) 2015; 94(16): e748. Dostupné z DOI: <http://dx.doi.org/10.1097/MD.0000000000000748>.
5. Miesen WM, Janssens EN, van Bommel EF. Diabetes insipidus as the presenting symptom of Wegener’s granulomatosis. Nephrol Dial Transplant. 1999; 14(2): 426–429.
6. Garovic VD, Clarke BL, Chilson TS et al. Diabetes insipidus and anterior pituitary insufficiency as presenting features of Wegener’s granulomatosis. Am J Kidney Dis 2001; 37(1): E5.
7. Al-Fakhouri A, Manadan A, Gan J et al. Central diabetes insipidus as the presenting symptom of granulomatosis with polyangiitis. J Clin Rheumatol. 2014; 20(3): 151–154.
8. Yong TY, Li JY, Amato L et al. Pituitary involvement in Wegener’s granulomatosis. Pituitary 2008; 11(1): 77–84.
9. Kapoor E, Cartin-Ceba R, Specks U et al. Pituitary dysfunction in granulomatosis with polyangiitis: the Mayo Clinic experience. J Clin Endocrinol Metab 2014; 99(11): 3988–3994.
10. Düzgün N, Morris Y, Güllü S et al. Diabetes insipidus presentation before renal and pulmonary features in a patient with Wegener’s granulomatosis. Rheumatol Int 2005; 26(1): 80–82.
11. Czarnecki EJ, Spickler EM. MR demonstration of Wegener granulomatosis of the infundibulum, a cause of diabetes insipidus. AJNR Am J Neuroradiol 1995; 16(4 Suppl): 4S968–4S970.
12. Tenorio Jimenez C, Montalvo Valdivieso A, López Gallardo G et al. Pituitary involvement in Wegener’s granulomatosis: unusual biochemical findings and severe malnutrition. BMJ Case Rep 2011; 2011. pii: bcr0220113850.Dostupné z DOI: <http://dx.doi.org/10.1136/bcr.02.2011.3850>.
13. Spísek R, Kolouchová E, Jensovský J et al. Combined CNS and pituitary involvement as a primary manifestation of Wegener granulomatosis. Clin Rheumatol 2006; 25(5): 739–742.
14. Tappouni R, Burns A. Pituitary involvement in Wegener’s granulomatosis. Nephrol Dial Transplant 2000; 15(12): 2057–2058.
15. Hoffman GS, Kerr GS, Leavitt RY et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 1992; 116(6): 488–498.
16. Fujisawa I. Magnetic resonance imaging of the hypothalamic-neurohypophyseal system. J Neuroendocrinol 2004; 16(4): 297–302.
Labels
Diabetology Endocrinology Internal medicine
Article was published inInternal Medicine
2016 Issue 7-8-
All articles in this issue
- Estimating the prevalence of potential drug interactions in patients treated with 5 and more drugs in the Czech Republic and Slovac Repuplic
-
Autoimmune insulitis in patients with type 2 diabetes mellitus
A randomized clinical trial in hospitalized patients - Clinical contribution of new basal analogue insulin
- Changes in nutritional recommendations for a healthy population and their influence on a diabetic diet
- Impaired hypoglycemia awareness in diabetes mellitus
- Treatment of liver cirrhosis – actually possibility of ambulant internist
- Hypoglycemia as a symptom of cancer in adults
- Sepsis – how to recognize and what to focus on – back to basics in the light of the new definition
- The skin – a mirror of internal diseases
- The effect of antidiabetic treatment on the bone of patients with type 2 diabetes
- The benefit of urgent endoscopic retrograde cholangiopancreatography for the therapy of acute pancreatitis
- Type 2 diabetes mellitus and heart failure
- The differential diagnosis of pleural effusions
- Adverse effects of biological therapy in rheumatology
-
Possibilities of influencing cardiovascular risk in type 2 diabetes mellitus by antidiabetic treatment
Lowering of cardiovascular risk in treatment with liraglutide – Results of the LEADER - Methanol: the threat of intoxication is still there
- Diabetic retinopathy: pathogenesis and therapeutic implications
- The difference and ratio between serum concentrations of natrium and chlorides in patients with hyponatremia
- Systolic blood pressure targets
- Clinical significance of natriuretic peptides in the differential diagnosis of dyspnea
- Heart failure with preserved ejection fraction
- A near future of treatment of dyslipidemia in type 2 diabetics
- Glucagon antagonists open a new way in treatment of type 2 diabetes Mellitus
- Breviary of diabetes education for internist
- Prevention and therapy of sarcopenia in the ageing
- Granulomatosis with polyangiitis manifested as diabetes insipidus
- Internal Medicine
- Journal archive
- Current issue
- Online only
- About the journal
Most read in this issue- Treatment of liver cirrhosis – actually possibility of ambulant internist
- Sepsis – how to recognize and what to focus on – back to basics in the light of the new definition
- The skin – a mirror of internal diseases
- Prevention and therapy of sarcopenia in the ageing
Login#ADS_BOTTOM_SCRIPTS#Forgotten passwordEnter the email address that you registered with. We will send you instructions on how to set a new password.
- Career