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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.<\/jats:p>","DOI":"10.1136\/bcr-2020-237774","type":"journal-article","created":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T12:51:18Z","timestamp":1611838278000},"page":"e237774","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Relapsed granulomatosis with polyangiitis with panhypopituitarism"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-775X","authenticated-orcid":false,"given":"Matthew J","family":"Triano","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William D","family":"Haberstroh","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhishek","family":"Lenka","sequence":"additional","affiliation":[{"name":"Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean A","family":"Whelton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA"},{"name":"Division of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"2025082706575754000_14.1.e237774.1","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1007\/s00296-019-04338-0","article-title":"Pituitary involvement in patients with granulomatosis with polyangiitis: case series and literature review","volume":"39","author":"Gu","year":"2019","journal-title":"Rheumatol Int"},{"key":"2025082706575754000_14.1.e237774.2","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1007\/s11102-017-0811-0","article-title":"Pituitary dysfunction in granulomatosis with polyangiitis","volume":"20","author":"Esposito","year":"2017","journal-title":"Pituitary"},{"key":"2025082706575754000_14.1.e237774.3","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/RHU.0000000000000093","article-title":"Central diabetes insipidus as the presenting symptom of granulomatosis with polyangiitis","volume":"20","author":"Al-Fakhouri","year":"2014","journal-title":"J Clin Rheumatol"},{"key":"2025082706575754000_14.1.e237774.4","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11102-007-0016-z","article-title":"Fatal inflammatory hypophysitis","volume":"10","author":"McIntyre","year":"2007","journal-title":"Pituitary"},{"key":"2025082706575754000_14.1.e237774.5","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s10067-019-04735-7","article-title":"Pituitary dysfunction in granulomatosis with polyangiitis","volume":"39","author":"Vega-Beyhart","year":"2020","journal-title":"Clin Rheumatol"},{"key":"2025082706575754000_14.1.e237774.6","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.rdc.2017.06.006","article-title":"Central nervous system disease in antineutrophil cytoplasmic Antibodies-Associated vasculitis","volume":"43","author":"Graf","year":"2017","journal-title":"Rheum Dis Clin North Am"},{"key":"2025082706575754000_14.1.e237774.7","doi-asserted-by":"crossref","first-page":"3988","DOI":"10.1210\/jc.2014-1962","article-title":"Pituitary dysfunction in granulomatosis with polyangiitis: the Mayo clinic experience","volume":"99","author":"Kapoor","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082706575754000_14.1.e237774.8","unstructured":"Pekic S , Miljic D , Popovic V . 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