Skip to main content

Advertisement

SpringerLink
Log in

Pituitary dysfunction in granulomatosis with polyangiitis

  • Case Based Review
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis of small vessels that affect the pituitary gland in less than 1% of cases being exceptionally rare. To describe the clinical, biochemical, radiological findings, treatment, and outcomes of 4 patients with GPA-related hypophysitis. A systematic review of published cases with the same diagnosis is presented as well. A cross-sectional case series of patients with hypophysitis due to GPA from 1981 to 2018 at a third level specialty center. Literature review was performed searching in seven different digital databases for terms “granulomatosis with polyangiitis” and “pituitary gland” or “hypophysitis,” including in the analysis all published cases between 1950 and 2019 with a minimum follow-up of 6 months. We found 197 patients with GPA in our institution of whom 4 patients (2.0%) had pituitary involvement. Clinical characteristics and outcomes are described. We also reviewed 7 case series, and 36 case reports describing pituitary dysfunction related to GPA from 1953 to 2019, including the clinical picture of an additional 74 patients. Pituitary dysfunction due to GPA is rare. Treatment is targeted to control systemic manifestations; nevertheless, the outcome of the pituitary function is poor. Central diabetes insipidus, particularly in younger women with other systemic features, should raise suspicion of GPA.

Key Points

• Involvement of the pituitary gland is an uncommon manifestation in GPA patients. The presence of central diabetes insipidus in the setting of systemic symptoms should prompt its suspicion.

• In patients with pituitary involvement due to GPA, affection of other endocrine glands is rare, neither concomitant nor in different times during the disease course. This may arise the hypothesis of a local or regional pathogenesis affection of the gland.

• There is no consensus on the best therapy strategy for GPA hypophysitis. Although the use of glucocorticoids with CYC is the most common drug combination, no differences in the outcome of the pituitary function and GPA disease course are seen with other immunosuppressants.

• Poor prognosis regarding pituitary function is expected due to possible permanent pituitary tissue damage that results in the need of permanent hormonal replacement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Faje A (2016) Hypophysitis: evaluation and management. Clin Diabetes Endocrinol 2(1):15. https://doi.org/10.1186/s40842-016-0034-8

    Article  PubMed  PubMed Central  Google Scholar 

  2. Shi J, Zhang JM, Wu Q, Chen G, Zhang H, Bo WL (2009) Granulomatous hypophysitis: two case reports and literature review. J Zhejiang Univ Sci B 10(7):552–558. https://doi.org/10.1631/jzus.B0820355

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lury KM (2005) Inflammatory and infectious processes involving the pituitary gland. Top Magn Reson Imaging 16(4):301–306. https://doi.org/10.1097/01.rmr.0000224686.21748.ea

    Article  PubMed  Google Scholar 

  4. Gordon MS, Gordon MB (2016) Occult Langerhans cell Histiocytosis presenting with papillary thyroid carcinoma, a thickened pituitary stalk and diabetes insipidus. Case Rep Endocrinol 2016:1–3. https://doi.org/10.1155/2016/5191903

    Article  Google Scholar 

  5. Lamprecht P, Gross WL (2004) Wegener’s granulomatosis. Herz 29(1):47–56. https://doi.org/10.1007/s00059-004-2525-0

    Article  PubMed  Google Scholar 

  6. Almouhawis HA, Leao JC, Fedele S, Porter SR (2013) Wegener’s granulomatosis: a review of clinical features and an update in diagnosis and treatment. J Oral Pathol Med 42(7):507–516. https://doi.org/10.1111/jop.12030

    Article  PubMed  Google Scholar 

  7. Nishino H, Rubino FA, DeRemee RA, Swanson JW, Parisi JE (1993) Neurological involvement in Wegener’s granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic. Ann Neurol 2018 33(1):4–9. https://doi.org/10.1002/ana.410330103

    Article  CAS  PubMed  Google Scholar 

  8. Higuera-Ortiz V, Reynoso A, Ruiz N, Delgado-Hernández RD, Gómez-Garza G, Flores-Suárez LF (2017) Pachymeningitis in granulomatosis with polyangiitis: case series with earlier onset in younger patients and literature review. Clin Rheumatol 36(4):919–924. https://doi.org/10.1007/s10067-016-3520-6

    Article  PubMed  Google Scholar 

  9. De Parisot A, Puéchal X, Langrand C et al (2015) Pituitary involvement in granulomatosis with polyangiitis: report of 9 patients and review of the literature. Medicine (Baltimore) 94(16):1–13. https://doi.org/10.1097/MD.0000000000000748

    Article  Google Scholar 

  10. Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP, Calabrese LH, Fries JF, Lie JT, Lightfoot RW Jr, Masi AT, McShane DJ, Mills JA, Stevens MB, Wallace SL, Zvaifler NJ (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 33(8):1101–1107. https://doi.org/10.1002/art.1780330807

    Article  CAS  PubMed  Google Scholar 

  11. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CGM, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DGI, Specks U, Stone JH, Takahashi K, Watts RA (2013) 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65(1):1–11. https://doi.org/10.1002/art.37715

    Article  CAS  PubMed  Google Scholar 

  12. Stone JH, Hoffman GS, Merkel PA, Min YI, Uhlfelder ML, Hellmann DB, Specks U, Allen NB, Davis JC, Spiera RF, Calabrese LH, Wigley FM, Maiden N, Valente RM, Niles JL, Fye KH, McCune JW, St.Clair EW, Luqmani RA, for the International Network for the Study of the Systemic Vasculitides (INSSYS) (2001) A disease-specific activity index for Wegener’s granulomatosis: modification of the Birmingham vasculitis activity score. Arthritis Rheum 44(4):912–920. https://doi.org/10.1002/1529-0131(200104)44:4<912::AID-ANR148>3.0.CO;2-5

    Article  CAS  PubMed  Google Scholar 

  13. Cunnington JR, Jois R, Zammit I, Scott D, Isaacs J (2009) Diabetes insipidus as a complication of Wegener’s granulomatosis and its treatment with biologic agents. Int J Rheumatol 2009:1–4. https://doi.org/10.1155/2009/346136

    Article  Google Scholar 

  14. Seror R, Mahr A, Ramanoelina J, Pagnoux C, Cohen P, Guillevin L (2006) Central nervous system involvement in wegener granulomatosis. Medicine (Baltimore) 85(1):54–65. https://doi.org/10.1097/01.md.0000200166.90373.41

    Article  Google Scholar 

  15. Al-Fakhouri A, Manadan A, Gan J, Sreih AG (2014) Central diabetes insipidus as the presenting symptom of granulomatosis with polyangiitis. J Clin Rheumatol 20(3):151–154. https://doi.org/10.1097/RHU.0000000000000093

    Article  PubMed  Google Scholar 

  16. Esposito D, Trimpou P, Giugliano D, Dehlin M, Ragnarsson O (2017) Pituitary dysfunction in granulomatosis with polyangiitis. Pituitary 20(5):594–601. https://doi.org/10.1007/s11102-017-0811-0

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kapoor E, Cartin-Ceba R, Specks U, Leavitt J, Erickson B, Erickson D (2014) Pituitary dysfunction in granulomatosis with polyangiitis: the mayo clinic experience. J Clin Endocrinol Metab 99(11):3988–3994. https://doi.org/10.1210/jc.2014-1962

    Article  CAS  PubMed  Google Scholar 

  18. Yong TY, Li JYZ, Amato L, Mahadevan K, Phillips PJ, Coates PS, Coates PTH (2018) Pituitary involvement in Wegener’s granulomatosis. Pituitary 11(1):77–84. https://doi.org/10.1007/s11102-007-0021-2

    Article  Google Scholar 

  19. Bando H, Iguchi G, Fukuoka H, Taniguchi M, Kawano S, Saitoh M, Yoshida K, Matsumoto R, Suda K, Nishizawa H, Takahashi M, Morinobu A, Kohmura E, Ogawa W, Takahashi Y (2015) A diagnostic pitfall in IgG4-related hypophysitis: infiltration of IgG4-positive cells in the pituitary of granulomatosis with polyangiitis. Pituitary 18(5):722–730. https://doi.org/10.1007/s11102-015-0650-9

    Article  CAS  PubMed  Google Scholar 

  20. McIntyre EA, Perros P (2007) Fatal inflammatory hypophysitis. Pituitary 10(1):107–111. https://doi.org/10.1007/s11102-007-0016-z

    Article  PubMed  Google Scholar 

  21. Sampei S, Watanabe R, Ishii T, Harigae H (2014) Granulomatosis with polyangiitis preceded by central diabetes insipidus. Intern Med 53(15):1725–1726. https://doi.org/10.2169/internalmedicine.53.2216

    Article  PubMed  Google Scholar 

  22. Christou L, Thomas A, Dutta S, Shaw S, Jose B (2017) Granulomatosis with polyangiitis presenting as a pituitary lesion. Br J Hosp Med (Lond) 78(4):234–234. https://doi.org/10.12968/hmed.2017.78.4.234

    Article  Google Scholar 

  23. Pereira EAC, Plaha P, Hofer M, Karavitaki N, Cudlip SA (2013) Hypophyseal Wegener’s granulomatosis presenting by visual field constriction without hypopituitarism. Clin Neurol Neurosurg 115(6):762–764. https://doi.org/10.1016/j.clineuro.2012.06.041

    Article  PubMed  Google Scholar 

  24. Banks D, Atherton H (1999) Letters to the editor. Rheumatology. 38:679–688. https://doi.org/10.1016/j.jtcvs.2007.03.053

    Article  Google Scholar 

  25. Czarnecki EJ, Spickler EM (1995) MR demonstration of Wegener granulomatosis of the infundibulum, a cause of diabetes insipidus. Am J Neuroradiol 16(4):968–970

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Van Durme CMPG, Kisters JMH, Van Paassen P, Van Etten RW, Tervaert JWC (2011) Multiple endocrine abnormalities. Lancet 378(9790):540. https://doi.org/10.1016/S0140-6736(11)60831-3

    Article  PubMed  Google Scholar 

  27. Tappouni R, Burns A (2000) Pituitary involvement in Wegener’s granulomatosis. Nephrol Dial Transplant 15:2057–2058. https://doi.org/10.1093/ndt/15.12.2057

    Article  CAS  PubMed  Google Scholar 

  28. Santoro SG, Guida AH, Furioso AE, Glikman P, Rogozinski AS (2011) Panhypopituitarism due to Wegener’s granulomatosis. Arq Bras Endocrinol Metabol 55(7):481–485. https://doi.org/10.1590/S0004-27302011000700008

    Article  PubMed  Google Scholar 

  29. Slabu H, Arnason T (2013) Pituitary granulomatosis with polyangiitis. BMJ Case Rep 1:1–5. https://doi.org/10.1136/bcr-2013-008656

    Article  Google Scholar 

  30. Vittaz L, Ramanoelina J, Mahr A, Cohen R, Cohen P, Reach G, Guillevin L (2004) Atteintes hypophysaires de la granulomatose de Wegener. Presse Med 33(22):1585–1590. https://doi.org/10.1016/S0755-4982(04)98998-1

    Article  PubMed  Google Scholar 

  31. Kim IY, Lee S, Kwon HJ, Lee K, Yoo KH, Cha HS, Koh EM, Lee J (2015) Pituitary granulomatosis with polyangiitis presenting with central diabetes insipidus. J Rheum Dis 22(3):195–199. https://doi.org/10.4078/jrd.2015.22.3.195

    Article  Google Scholar 

  32. Gandhi C, Chik C (2017) Pituitary involvement in granulomatosis with polyangiitis: a case report of 2 patients. Can J Diabetes 41(5):S35. https://doi.org/10.1016/j.jcjd.2017.08.107

    Article  Google Scholar 

  33. Baird SM, Pratap U, McLean C, Law CP, Maartens N (2017) Rare presentation of Wegener’s granulomatosis in the pituitary gland: case report and literature review. Int J Surg Case Rep 33:24–26. https://doi.org/10.1016/j.ijscr.2017.02.014

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hughes J, Barkhoudarian G, Ciarlini P, Laws E, Mody E, Inzucchi S, Woodmansee W (2012) Refractory pituitary granulomatosis with polyangiitis (Wegener’s) treated with rituximab. Endocr Pract 19(1):e1–e7. https://doi.org/10.4158/EP12181.CR

    Article  Google Scholar 

  35. Ahlstrom CG, Liedholm K, Truedsson E (1953) Respirato-renal type of polyarteritis nodosa. Acta Med Scand 144(5):323–332

    Article  CAS  PubMed  Google Scholar 

  36. Fliser D, Ritz E (2001) Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 37(1):79–83. https://doi.org/10.1053/ajkd.2001.20591

    Article  CAS  PubMed  Google Scholar 

  37. Barlas NB, Hassan HH, Al Badr FB, Bilal A (2011) Structural and functional involvement of pituitary gland in Wegener’s granulomatosis. Clin Neuroradiol 21(1):31–33. https://doi.org/10.1007/s00062-010-0037-2

    Article  CAS  PubMed  Google Scholar 

  38. Woywodt A, Knoblauch H, Kettritz R, Schneider W, Goebel U (2000) Sudden death and Wegener’s granulomatosis of the pituitary: case report. Scand J Rheumatol 29(4):264–266. https://doi.org/10.1080/030097400750041433

    Article  CAS  PubMed  Google Scholar 

  39. Mallory TB, Castleman B, Towne VW (1950) Case records of the Massachusets General Hospital. N Engl J Med 243(12):454–458

    Article  Google Scholar 

  40. Roberts GA, Eren E, Sinclair H, Pelling M, Burns A, Bradford R, Maurice-Williams R, Black CM, Finer N, Bouloux PMG (1995) Two cases of Wegener’s granulomatosis involving the pituitary. Clin Endocrinol 42(3):323–328. https://doi.org/10.1111/j.1365-2265.1995.tb01882.x

    Article  CAS  Google Scholar 

  41. Goyal M, Kucharczyk W, Keystone E (2000) Case report granulomatous hypophysitis due to Wegener’s granulomatosis. Ajnr:1466–1469

  42. Kara O, Demirel F, Acar BC, Cakar N (2013) Wegener granulomatosis as an uncommon cause of panhypopituitarism in childhood. J Pediatr Endocrinol Metab 26(9–10):959–962. https://doi.org/10.1515/jpem-2013-0033

    Article  PubMed  Google Scholar 

  43. Bertken RD, Cooper VR (1997) Wegener granulomatosis causing sellar mass, hydrocephalus, and global pituitary failure. West J Med 167(1):44–47

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Xue J, Wang H, Wu H, Jin Q (2009) Wegener’s granulomatosis complicated by central diabetes insipidus and peripheral neutrophy with normal pituitary in a patient. Rheumatol Int 29(10):1213–1217. https://doi.org/10.1007/s00296-008-0774-6

    Article  PubMed  Google Scholar 

  45. Muir BM, Hulett RL, Zorn JG (2004) Wegener’s granulomatosis complicated by central diabetes insipidus in a pediatric patient. AJR Am J Roentgenol 182(6):1560–1562. https://doi.org/10.2214/ajr.182.6.1821560

    Article  PubMed  Google Scholar 

  46. Hurst NP, Dunn NA, Chalmers TM (1983) Wegener’s granulomatosis complicated by diabetes insipidus. Ann Rheum Dis 42(5):600–601. https://doi.org/10.1136/ard.42.5.600

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Dutta P, Hayatbhat M, Bhansali A, Bambery P, Kakar N (2006) Wegener’s granulomatosis presenting as diabetes insipidus. Exp Clin Endocrinol Diabetes 114(9):533–536. https://doi.org/10.1055/s-2006-924122

    Article  CAS  PubMed  Google Scholar 

  48. Katzman GL, Langford CA, Sneller MC, Koby M, Patronas NJ (1999) Case report pituitary involvement by Wegener’s granulomatosis: a report of two cases. Pituitary:519–523

  49. Ohashi K, Morishita M, Watanabe H, Sada KE, Katsuyama T, Miyawaki Y, Katsuyama E, Narazaki M, Tatebe N, Watanabe K, Kawabata T, Wada J (2017) Central diabetes insipidus in refractory antineutrophil cytoplasmic antibody-associated vasculitis. Intern Med 56(21):2943–2948. https://doi.org/10.2169/internalmedicine.8683-16

    Article  PubMed  PubMed Central  Google Scholar 

  50. Špíšek R, Kolouchová E, Jenšovsky J et al (2006) Combined CNS and pituitary involvement as a primary manifestation of Wegener granulomatosis. Clin Rheumatol 25(5):739–742. https://doi.org/10.1007/s10067-005-0065-5

    Article  PubMed  Google Scholar 

  51. Moon KS, Lee JK, Kim TS, Jung S, Kim JH, Kim SH, Kang SS (2007) Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma. J Clin Neurosci 14(3):283–286. https://doi.org/10.1016/j.jocn.2005.11.016

    Article  PubMed  Google Scholar 

  52. Miesen WM, Janssens EN, van Bommel EF (1999) Diabetes insipidus as the presenting symptom of Wegener’s granulomatosis. Nephrol Dial Transplant 14(2):426–429. https://doi.org/10.1093/ndt/14.2.426

    Article  CAS  PubMed  Google Scholar 

  53. Düzgün N, Morris Y, Güllü S, Gürsoy A, Ensari A, Kumbasar ÖÖ, Duman M (2005) Diabetes insipidus presentation before renal and pulmonary features in a patient with Wegener’s granulomatosis. Rheumatol Int 26(1):80–82. https://doi.org/10.1007/s00296-005-0583-0

    Article  PubMed  Google Scholar 

  54. Karaca Z, Kelestimur F (2016) The management of hypophysitis. Minerva Endocrinol 41(3):390–399. https://doi.org/10.1136/bmj.2.4044.75

    Article  PubMed  Google Scholar 

  55. Faje A (2016) Immunotherapy and hypophysitis: clinical presentation, treatment, and biologic insights. Pituitary 19(1):82–92. https://doi.org/10.1007/s11102-015-0671-4

    Article  CAS  PubMed  Google Scholar 

  56. Langford CA (2001) Wegener granulomatosis. Am J Med Sci 321(1):76–82

    Article  CAS  PubMed  Google Scholar 

  57. de Groot K, Schmidt DK, Arlt AC, Gross WL, Reinhold-Keller E (2001) Standardized neurologic evaluations of 128 patients with Wegener granulomatosis. Arch Neurol 58(8):1215–1221. https://doi.org/10.1001/archneur.58.8.1215

    Article  PubMed  Google Scholar 

  58. Langrand C, Bihan H, Raverot G, Varron L, Androdias G, Borson-Chazot F, Brue T, Cathebras P, Pinede L, Muller G, Broussolle C, Cotton F, Valeyre D, Seve P (2012) Hypothalamo-pituitary sarcoidosis: a multicenter study of 24 patients. QJM 105(10):981–995. https://doi.org/10.1093/qjmed/hcs121

    Article  CAS  PubMed  Google Scholar 

  59. Henes M, Henes JC, Neunhoeffer E, von Wolff M, Schmalzing M, Kötter I, Lawrenz B (2012) Fertility preservation methods in young women with systemic lupus erythematosus prior to cytotoxic therapy: experiences from the FertiProtekt network. Lupus 21(9):953–958. https://doi.org/10.1177/0961203312442753

    Article  CAS  PubMed  Google Scholar 

  60. Turcu AF, Erickson BJ, Lin E, Guadalix S, Schwartz K, Scheithauer BW, Atkinson JLD, Young WF Jr (2013) Pituitary stalk lesions: the mayo clinic experience. J Clin Endocrinol Metab 98(5):1812–1818. https://doi.org/10.1210/jc.2012-4171

    Article  CAS  PubMed  Google Scholar 

  61. Chang SY, Keogh KA, Lewis JE, Ryu JH, Cornell LD, Garrity JA, Yi ES (2013) IgG4-positive plasma cells in granulomatosis with polyangiitis (Wegener’s): a clinicopathologic and immunohistochemical study on 43 granulomatosis with polyangiitis and 20 control cases. Hum Pathol 44(11):2432–2437. https://doi.org/10.1016/j.humpath.2013.05.023

    Article  CAS  PubMed  Google Scholar 

  62. Puéchal X, Iudici M, Calich AL, Vivot A, Terrier B, Régent A, Cohen P, Jeunne CL, Mouthon L, Ravaud P, Guillevin L (2018) Rituximab for induction and maintenance therapy of granulomatosis with polyangiitis: a single-centre cohort study on 114 patients. Rheumatology 58(3):401–409. https://doi.org/10.1093/rheumatology/key117

    Article  Google Scholar 

  63. Anthony J, Esper GJ, Ioachimescu A (2016) Hypothalamic–pituitary sarcoidosis with vision loss and hypopituitarism: case series and literature review. Pituitary 19(1):19–29. https://doi.org/10.1007/s11102-015-0678-x

    Article  CAS  PubMed  Google Scholar 

  64. Pekic S, Popovic V (2017) Diagnosis of endocrine disease: expanding the cause of hypopituitarism. Eur J Endocrinol 176(6):R269–R282. https://doi.org/10.1530/EJE-16-1065

    Article  CAS  PubMed  Google Scholar 

  65. Semple D, Keogh J, Forni L, Venn R (2004) Clinical review: vasculitis on the intensive care unit - part 2: treatment and prognosis. Crit Care 9(2):193–197. https://doi.org/10.1186/cc293

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We sincerely thank to the Department of Endocrinology and Metabolism at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran.

Author information

Authors and Affiliations

  1. Clínica de Neuroendocrinología, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, 14000, Mexico City, Mexico

    Arturo Vega-Beyhart, Milagros Fernández-Barrio, Ana Sofía Vargas-Castro, Lucía García-Inciarte, Alberto Guzmán-Pérez, Tania Raisha Torres-Victoria, Froylán David Martínez-Sánchez, Mireya Citlali Pérez-Guzmán, José Miguel Hinojosa-Amaya, Andrés León-Suárez, Miguel Angel Gómez-Sámano, Francisco Javier Gómez-Pérez & Daniel Cuevas-Ramos

  2. Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Irene Rocío Medina-Rangel & Andrea Hinojosa-Azaola

Authors
  1. Arturo Vega-Beyhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Rocío Medina-Rangel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Hinojosa-Azaola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Milagros Fernández-Barrio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana Sofía Vargas-Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lucía García-Inciarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alberto Guzmán-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tania Raisha Torres-Victoria
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Froylán David Martínez-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mireya Citlali Pérez-Guzmán
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. José Miguel Hinojosa-Amaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Andrés León-Suárez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Miguel Angel Gómez-Sámano
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Francisco Javier Gómez-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Daniel Cuevas-Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Research idea and study design: AVB, IRMD, AHA, DCR

Data acquisition: AVB, IRMD, MFB, ASFC, LGI, AGP, TTV, FDMS

Statistical analysis: AVB, DCR, MPG, JMHA

Data analysis/interpretation: AVB, IRMD, AHA, DCR, ALS, MAGS, FJGP

Manuscript drafting: AVB, IRMD, AHA, DCR, FDMS

Supervision and mentorship: DCR

Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Each author approved the version to be published.

Corresponding author

Correspondence to Daniel Cuevas-Ramos.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 4875 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vega-Beyhart, A., Medina-Rangel, I.R., Hinojosa-Azaola, A. et al. Pituitary dysfunction in granulomatosis with polyangiitis. Clin Rheumatol 39, 595–606 (2020). https://doi.org/10.1007/s10067-019-04735-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-019-04735-7

Keywords

Search

Navigation