Abstract：
BACKGROUND: Hypophysitis is a rare inflammatory disorder of the pituitary gland. Symptoms and signs of hypophysitis can be various, and its recognition may be challenging. Arginine vasopressin deficiency (AVP-D) due to exposure to a variety of drugs and toxic substances is rare, but some cases have been reported. Only 2 cases of AVP-D following toxic exposure to toluene, an aromatic hydrocarbon, have been reported in the literature. To our knowledge, our case represents the first description of an infundibulo neurohypophysitis (INH), manifested with AVP-D, secondary to inhalation of toluene.
METHODS: A 59-year-old man with an unremarkable medical history was referred to our department for headache, polyuria, and polydipsia after the inhalation of spray film containing toluene. The blood tests revealed a hyperosmolar plasma hypernatremia with normal kidney function. A desmopressin test was performed, with an improvement in water balances, blood electrolytes, and diuresis contraction. A pituitary MRI detected the absence of a normal hyperintense signal of the neuro-pituitary in the T1-weighted images. In consideration of the clinical signs and radiological imaging suggestive of INH, a therapy with desmopressin and corticosteroids was instituted, with gradual improvement of polyuria and resolution of the radiological features of INH.
CONCLUSIONS: The exceptional finding of INH, manifested with AVP-D, following toluene inhalation could represent a new secondary cause of hypophysitis. The possibility that drugs or toxic substances never reported before could induce INH should not be excluded since the study on hypophysitis is relatively recent but emerging, predictably destined to increase exponentially in the coming years.
METHODS: A 59-year-old man with an unremarkable medical history was referred to our department for headache, polyuria, and polydipsia after the inhalation of spray film containing toluene. The blood tests revealed a hyperosmolar plasma hypernatremia with normal kidney function. A desmopressin test was performed, with an improvement in water balances, blood electrolytes, and diuresis contraction. A pituitary MRI detected the absence of a normal hyperintense signal of the neuro-pituitary in the T1-weighted images. In consideration of the clinical signs and radiological imaging suggestive of INH, a therapy with desmopressin and corticosteroids was instituted, with gradual improvement of polyuria and resolution of the radiological features of INH.
CONCLUSIONS: The exceptional finding of INH, manifested with AVP-D, following toluene inhalation could represent a new secondary cause of hypophysitis. The possibility that drugs or toxic substances never reported before could induce INH should not be excluded since the study on hypophysitis is relatively recent but emerging, predictably destined to increase exponentially in the coming years.
摘要：
背景：垂体炎是一种罕见的垂体炎性疾病。垂体炎的症状和体征可能多种多样，它的识别可能具有挑战性。精氨酸加压素缺乏症（AVP-D）由于暴露于各种药物和有毒物质是罕见的，但是已经报道了一些病例。只有2例AVP-D中毒暴露于甲苯后，芳香烃,已在文献中报道。据我们所知,我们的病例代表了漏斗神经垂体炎（INH）的第一个描述，表现为AVP-D，其次是吸入甲苯。
方法：一名59岁、病史无异常的男性因头痛被转诊至本科，多尿,和多饮后吸入含甲苯的喷雾膜。血液检查显示高渗性血浆高钠血症，肾功能正常。进行去氨加压素试验,随着水平衡的改善，血液电解质,和利尿收缩。垂体MRI在T1加权图像中检测到神经垂体不存在正常的高强度信号。考虑到临床体征和放射学影像学提示异烟肼，开始使用去氨加压素和皮质类固醇治疗，随着多尿症的逐渐改善和异烟肼放射学特征的消退。
结论：INH的特殊发现，表现为AVP-D，吸入甲苯后可能是垂体炎的一个新的次要原因。不应排除以前从未报道过的药物或有毒物质可能诱发异烟肼的可能性，因为对垂体炎的研究相对较新，但正在出现。可以预见的是，未来几年将呈指数级增长。
方法：一名59岁、病史无异常的男性因头痛被转诊至本科，多尿,和多饮后吸入含甲苯的喷雾膜。血液检查显示高渗性血浆高钠血症，肾功能正常。进行去氨加压素试验,随着水平衡的改善，血液电解质,和利尿收缩。垂体MRI在T1加权图像中检测到神经垂体不存在正常的高强度信号。考虑到临床体征和放射学影像学提示异烟肼，开始使用去氨加压素和皮质类固醇治疗，随着多尿症的逐渐改善和异烟肼放射学特征的消退。
结论：INH的特殊发现，表现为AVP-D，吸入甲苯后可能是垂体炎的一个新的次要原因。不应排除以前从未报道过的药物或有毒物质可能诱发异烟肼的可能性，因为对垂体炎的研究相对较新，但正在出现。可以预见的是，未来几年将呈指数级增长。
