Journal Article

Lymphocytic panhypophysitis and anti-rabphilin-3A antibody with pulmonary sarcoidosis

Iwata Naoko, Sugimura Yoshihisa, Suzuki, Atsushi, Shimizu Ai, Nakamura, Akinobu, Konno Satoshi, Fujisawa Haruki, Nishimura Hiroki, Atsumi Tatsuya, Cho, Kyu Yong, Miyoshi Hideaki, Miya Aika, Kameda Hiraku, Kimura Hirokazu, Nomoto, Hiroshi, Matsuno Yoshihiro, Okamoto Michinari, Motegi Hiroaki, Suzuki, Masaru, Takahashi, Yuka

2022

Overview

PurposeTo explore the clinical significance of anti-rabphillin-3A antibody for the differential diagnosis of lymphocytic panhypophysitis. Methods and resultsA 58-year-old Japanese man developed uveitis of unknown cause in 2017. In 2019, he became aware of polyuria. In August 2020, he noticed transient diplopia and was diagnosed with right abducens nerve palsy. At the same time, he complained of fatigue and loss of appetite. Head magnetic resonance imaging demonstrated enlargement of the pituitary stalk and pituitary gland, corresponding to hypophysitis. Hormone stimulation tests showed blunted responses with respect to all anterior pituitary hormones. Central diabetes insipidus was diagnosed on the basis of a hypertonic saline loading test. Taking these findings together, a diagnosis of panhypopituitarism was made. Computed tomography showed enlargement of hilar lymph nodes. Biopsies of the hilar lymph nodes revealed non-caseating epithelioid cell granulomas that were consistent with sarcoidosis. Biopsy of the anterior pituitary revealed mild lymphocyte infiltration in the absence of IgG4-positive cells, non-caseating granulomas, or neoplasia. Western blotting revealed the presence of anti-rabphilin-3A antibody, supporting a diagnosis of lymphocytic panhypophysitis. Because the patient had no visual impairment or severe uveitis, we continued physiological hormone replacement therapy and topical steroid therapy for the uveitis.ConclusionTo the best of our knowledge, this is the first case of anti-rabphilin 3A antibody positive lymphocytic panhypophysitis comorbid with sarcoidosis, diagnosed by both pituitary and hilar lymph node biopsy. The utility of anti-rabphilin-3A antibody for the differential diagnosis of hypophysitis like this case should be clarified with further case studies.

• Publisher: Springer Nature B.V
• Subject: Abducens nerve / Antibodies / Appetite loss / Biopsy / Case studies / Computed tomography / Diabetes insipidus / Differential diagnosis / Enlargement / Granulomas / Hormone replacement therapy / Immunoglobulin G / Lymph nodes / Lymphatic system / Lymphocytes / Magnetic resonance imaging / Paralysis / Pituitary (anterior) / Pituitary hormones / Polyuria / Sarcoidosis / Uveitis / Western blotting