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Relapsed granulomatosis with polyangiitis with panhypopituitarism
  1. Matthew J Triano1,
  2. William D Haberstroh2,
  3. Abhishek Lenka3 and
  4. Sean A Whelton1,4
  1. 1Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA
  2. 2Division of General Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
  3. 3Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
  4. 4Division of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA
  1. Correspondence to Matthew J Triano; mjt92{at}


A man in his early 60s with a medical history of granulomatosis with polyangiitis (GPA) in remission for two decades without maintenance therapy presented with non-specific complaints of profound fatigue and 40-pound weight loss. He was seronegative for antinuclear antibodies and cytoplasmic antineutrophilic antibodies, but erythrocyte sedimentation rate and C reactive protein levels were elevated. Endocrinological testing revealed adrenal insufficiency, hypogonadism, hypothyroidism and diabetes insipidus. An MRI of the head revealed extensive sinonasal inflammation eroding through the floor of the sella turcica and into the pituitary gland and stalk. Biopsy of the sinonasal tissues was inconclusive. On review of his case, a multidisciplinary team diagnosed him with panhypopituitarism secondary to a recurrence of GPA. He responded well to glucocorticoids and methotrexate with marked reduction of pituitary enhancement on imaging and resolution of diabetes insipidus. He will require lifelong testosterone, levothyroxine and glucocorticoids for hormone replacement therapy.

  • endocrinology
  • pituitary disorders
  • rheumatology
  • vasculitis

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  • Contributors The patient was under the care of SAW, WDH, AL and MJT in hospital. Investigation and drafting of the manuscript by MJT. Manuscript revised and approved by SAW, WDH and AL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.