Sandoval-Carrillo CT, Cantú-Brito C, Sandoval-Carrillo BG, Reyes MI, Díaz-Ramírez JB, Chiquete E

Language: Spanish
References: 7
Page: 113-119
PDF size: 1046.42 Kb.

ABSTRACT

Introduction: Granulomatosis with polyangiitis (formerly Wegener’s granulomatosis) is a systemic necrotizing vasculitis that usually affects the lungs and respiratory tract. The associated neurologic manifestations have been described in almost half of cases and most of them affect the peripheral nerves. The pituitary implication is uncommon.
Case report: We present the case of a 50-yearold woman who met diagnostic criteria for granulomatosis with polyangiitis, having started with the classic superior and inferior respiratory condition, with pulmonary tomographic imaging that showed classic lesions in parenchyma and pleura, and a lung biopsy compatible with the diagnosis, associated with positivity to ANCA antibodies. Subsequently it was documented gastrointestinal and skin implication, with excellent response to steroid treatment. Months later the patient presented with progressive headache, polyuria and other clinical and laboratory data compatible with panhypopituitarism. By means of a head magnetic resonance it was documented involvement of the structures of the sella turcica and pituitary gland, which responded favorably to cyclophosphamide and steroids.
Conclusions: Our case of granulomatosis with polyangiitis with pituitary implication exhibited an optimal response to immunosuppressive treatment, which is consistent with what has been reported in the international literature.

REFERENCES

1. Nishino H, Rubino FA, De Remee, RA, Swanson JW, Parisi JE. Neurological Involvement in Wegener`s granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic. Ann Neurol 1993; 33: 4-9.

2. Rosete A, Cabral AR, Kraus A, Alarcon Segovia D. Diabetes insipidus secondary to Wegener`s granulomatosis: report and review of the literatura. J Rheumatol 1991; 18: 761-765.

3. Roberts GA, Eren E, Sinclair H, et al. Two cases of Wegener`s granulomatosis involving the pituitary. Clin Endocrinol 1995; 42: 323-328.

4. Lohr KM, Ryan LM, Toohill RJ, et al. Anterior pituitary involvement in Wegener`s granulomatosis. J Rheumatol 1988; 15: 855-857.

5. Leavitt RY, Fauci AS, Bloch DA, et al. The American College of Reumotology 1990 criteria for the classification of Wegener`s granulomatosis. Arthritis Rheum 1990; 33: 1101-1107.

6. 6. Drachman DA. Neurological complications of Wegener`s granulomatosis. Arch Neurol. 1963; 8: 145-155.

7. Czarnecki Ej, Spickler EM. Demonstration of Wegener`s granulomatosis of the infundibulum, a cause of diabetes insipidus. AJNR 1995; 16: 968-970.