Panhypopituitarism associated with severe retroperitoneal fibrosis

A 43-year-old man, with a history of central diabetes insipidus diagnosed 3 years previously, complained about reduced libido. An MRI scan showed a su prasellar lesion just below the supraoptic recess of the third ventricle. A stereotactically guided biopsy revealed fibrous glia, but no other specifi c tissue and no inflammatory cells. Two months later the patient presented with fatigue and muscular weakness. Tertiary adrenal failure and hypothyroi dism were diagnosed by endocrine function tests and therapy with levothyrox ine and hydrocortisone was started.Another 2 months later the patient was a dmitted with giddiness, nausea, peripheral oedema and oliguria. Radiologica l imaging and an open transperitoneal kidney exploration showed severe fibr osis around both ureters. Histological examination confirmed the diagnosis of idiopathic retroperitoneal fibrosis. Presumably the suprasellar tumour was the first manifestation of retroperit oneal fibrosis. Once the diagnosis 'idiopathic retroperitoneal fibrosis' is confirmed, fibrotic manifestations and complications involving extra-retro peritoneal tissues including the endocrine system, should be sought.