Endocrine Abstracts

Case: Thirty seven years old patient whose complaint was head ache was seen in the out patient clinic for the follow up of her hormone replacement therapy. First time she was admitted to hospital with the complaint of confusion was in 2013. Her cranial MRI revelaed enlargement of optic chiasma with the possible diagnossis of optic chiasmatic glioma. Biopsy was taken out from this mass twice in July and November of 2013. In histological examinations, there were B and T lymphocytes, eosinophils and histiocytes. Lymphoid malignancies was rulled out by IHC staining. The patient has the diagnosis of panhypopituitarism since 2013. She was taking cortisol, l-thyroxine, desmopressin replacement therapies. Since she had pulmonary thromboembolism in her past medical history, estrogen replacement was given as transdermal estrogen. She has also been using insulin treatment for diabetes mellitus. Recently, her state of consciousness decreased and has been operated urgently, in another health institution. The preoperative pituitary MRI revealed that there was contrast enhancement around hypothalmic-chiasmatic region including pituitary stalk. Cranial MRI showed a lesion located at right caudate nucleus measured as 2.5×1.6 cm in diameters causing edema in white matter. Histopathology was consultated with the pathologist of our center and it was reported as infiltraiton of lymphocytes, plasma cells and histiocytes. It was stated that IgG4 positivity (> 50%) of plasma cells could be taken as a sign of “IgG4 associated disease”.

Conclusion: Recurrent mass lesions at the suprasellar region could be due to IgG4 associated disease. Immunosuppressive treatment should be discussed with this possible diagnosis.