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

Midori Sasaki Yatabe; Kimio Watanabe; Yoshimitsu Hayashi; Junichi Yatabe; Satoshi Morimoto; Atsuhiro Ichihara; Masaaki Nakayama; Tsuyoshi Watanabe

doi:10.2169/internalmedicine.56.6648

CASE REPORTS

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

Midori Sasaki Yatabe, Kimio Watanabe, Yoshimitsu Hayashi, Junichi Yatabe, Satoshi Morimoto, Atsuhiro Ichihara, Masaaki Nakayama, Tsuyoshi Watanabe

Author information

Midori Sasaki Yatabe
Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
Kimio Watanabe
Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
Yoshimitsu Hayashi
Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
Junichi Yatabe
Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
Satoshi Morimoto
Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
Atsuhiro Ichihara
Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Japan
Masaaki Nakayama
Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
Tsuyoshi Watanabe
Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan

Keywords: IgG4-related disease, retroperitoneal fibrosis, pituitary, diabetes insipidus, polyuria, prednisolone

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 1 Pages 47-53

DOI https://doi.org/10.2169/internalmedicine.56.6648

Details

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.

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