Lupus-Associated Autoimmune Hypophysitis: A Rare Case

TL;DR

This paper reports a rare case of autoimmune hypophysitis linked to lupus, where a man showed infertility and diabetes insipidus as initial symptoms.

Contribution

The novelty lies in presenting an unusual clinical presentation of SLE-associated autoimmune hypophysitis with infertility and diabetes insipidus as initial signs.

Findings

The patient exhibited hypogonadotropic hypogonadism and low IGF-1 levels.

MRI findings were consistent with autoimmune hypophysitis.

The patient improved with desmopressin and hCG therapy.

Abstract

Autoimmune hypophysitis (AH) is a rare inflammatory disorder of the pituitary gland, and its association with systemic lupus erythematosus (SLE) is extremely uncommon. We describe a 36-year-old man with newly diagnosed SLE who later developed fatigue, infertility, polyuria, and polydipsia. Hormonal evaluation revealed hypogonadotropic hypogonadism and low IGF-1. MRI showed pituitary stalk thickening and loss of the posterior pituitary bright spot, consistent with AH. Central diabetes insipidus (CDI) was confirmed by urine testing. The patient improved clinically after initiation of desmopressin and human chorionic gonadotropin (hCG) therapy. This case is notable because infertility and CDI were the initial manifestations of SLE-associated AH, representing an unusual clinical presentation that clinicians should be aware of.

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