Development of Graves’ disease in a patient with lymphocytic hypophysitis following glucocorticoid treatment
We report the case of a 41-year-old Japanese woman with visual field disturbances during late pregnancy. At 39 weeks of gestation, she was diagnosed with bitemporal hemianopsia at the ophthalmology department. An MRI revealed a symmetrical pituitary gland enlargement, compressing the optic chiasm. A...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Bioscientifica
2025-06-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Subjects: | |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2025/2/EDM-24-0145.xml |
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| Summary: | We report the case of a 41-year-old Japanese woman with visual field disturbances during late pregnancy. At 39 weeks of gestation, she was diagnosed with bitemporal hemianopsia at the ophthalmology department. An MRI revealed a symmetrical pituitary gland enlargement, compressing the optic chiasm. An emergency cesarean section was performed immediately, resulting in the delivery of a male infant weighing 3,112 grams. Laboratory tests indicated low serum free thyroxine (T4), thyroid-stimulating hormone (TSH), cortisol, luteinizing hormone, and follicle-stimulating hormone. The patient was clinically diagnosed with lymphocytic hypophysitis (LHy). Due to her visual field impairment, she was administered 60 mg of prednisolone daily. After 2 days, her visual field impairment improved rapidly, leading to a gradual tapering of the dose. Six months after treatment initiation, an MRI showed shrinkage of the pituitary gland. Her prednisolone dose was reduced to 5 mg daily, and she was switched to hydrocortisone at 15 mg daily. Twelve months after starting treatment, the patient developed thyrotoxicosis. Testing revealed a positive TSH receptor antibody, resulting in a diagnosis of Graves’ disease (GD). Treatment with thiamazole (15 mg daily) and potassium iodide (76 mg daily) was initiated, and her thyroid function normalized after 2 months. LHy is believed to have an autoimmune mechanism and is frequently associated with other autoimmune diseases; however, the development of GD is rare. Development of Graves’ disease should be considered in patients with LHy, particularly during the postpartum period and the glucocorticoid treatment process. |
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| ISSN: | 2052-0573 |