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

Intern Med. 2017;56(1):47-53. doi: 10.2169/internalmedicine.56.6648. Epub 2017 Jan 1.

Abstract

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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Diabetes Insipidus / complications*
  • Diabetes Insipidus / drug therapy
  • Diabetes Insipidus / physiopathology
  • Diuresis / drug effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Hypophysitis / drug therapy
  • Hypophysitis / physiopathology*
  • Immunoglobulin G / adverse effects*
  • Immunoglobulin G / blood
  • Male
  • Middle Aged
  • Polyuria / chemically induced
  • Polyuria / drug therapy
  • Polyuria / etiology*
  • Renal Insufficiency / drug therapy
  • Renal Insufficiency / etiology*
  • Retroperitoneal Fibrosis / physiopathology*
  • Treatment Outcome

Substances

  • Glucocorticoids
  • Immunoglobulin G