Overlap syndrome between sarcoidosis and Sjögren’s disease presenting as hypopituitarism: case report and review of literature
Abstract
Sarcoidosis is a granulomatous disease that affects multiple organs; however, pituitary involvement is extremely rare. Although autoimmune diseases, such as Sjögren's disease (SjD), may coexist, overlapping cases presenting with hypopituitarism are exceedingly rare. A 76-year-old man was admitted with hyponatremia and altered consciousness as chief complaints. Endocrine testing revealed panhypopituitarism, and magnetic resonance imaging showed pituitary gland and pituitary stalk enlargement with homogeneous enhancement. Whole-body imaging revealed extensive lymphadenopathy. Histological examination of lymph node and lung biopsy specimens revealed non-necrotizing granulomas, indicative of sarcoidosis. Salivary gland biopsy and autoantibody testing confirmed the presence of concomitant SjD. Hormone replacement therapy markedly improved pituitary enlargement and pituitary hormone secretion, allowing the discontinuation of replacement therapy after 137 days. However, despite the improvement in pituitary and lymph node lesions, interstitial pneumonia subsequently developed due to SjD, necessitating systemic immunosuppressive therapy. In conclusion, this case demonstrates a rare overlap between sarcoidosis presenting with hypopituitarism and SjD, in which pituitary lesions improved, but immune activity progressed in other organs. Thus, immune-mediated disease activity may differ between organs in overlapping syndromes, and pituitary lesions in sarcoidosis do not necessarily parallel systemic disease activity.
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BibTeX
@article{iwamoto2026overlap,
title = {{Overlap syndrome between sarcoidosis and Sjögren’s disease presenting as hypopituitarism: case report and review of literature}},
author = {Yuichiro Iwamoto and Noriko Yoshimura and Ayaka Harada and Yoshiro Fushimi and Yui Okamoto and Tomohiko Kimura and Masashi Shimoda and Shuhei Nakanishi and Yo Mizuta and Saeko Tsurui and Seiji Matsumoto and Yoshikazu Koike and Takehiro Nishimura and Hideaki Kaneto},
journal = {Endocrine Journal},
year = {2026},
month = aug,
doi = {10.1507/endocrj.ej26-0063},
url = {https://www.jstage.jst.go.jp/article/endocrj/73/8/73_EJ26-0063/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Overlap syndrome between sarcoidosis and Sjögren’s disease presenting as hypopituitarism: case report and review of literature
AU - Yuichiro Iwamoto
AU - Noriko Yoshimura
AU - Ayaka Harada
AU - Yoshiro Fushimi
AU - Yui Okamoto
AU - Tomohiko Kimura
AU - Masashi Shimoda
AU - Shuhei Nakanishi
AU - Yo Mizuta
AU - Saeko Tsurui
AU - Seiji Matsumoto
AU - Yoshikazu Koike
AU - Takehiro Nishimura
AU - Hideaki Kaneto
PY - 2026
DA - 2026/08/03
JO - Endocrine Journal
DO - 10.1507/endocrj.ej26-0063
UR - https://www.jstage.jst.go.jp/article/endocrj/73/8/73_EJ26-0063/_article
AB - Sarcoidosis is a granulomatous disease that affects multiple organs; however, pituitary involvement is extremely rare. Although autoimmune diseases, such as Sjögren's disease (SjD), may coexist, overlapping cases presenting with hypopituitarism are exceedingly rare. A 76-year-old man was admitted with hyponatremia and altered consciousness as chief complaints. Endocrine testing revealed panhypopituitarism, and magnetic resonance imaging showed pituitary gland and pituitary stalk enlargement with homogeneous enhancement. Whole-body imaging revealed extensive lymphadenopathy. Histological examination of lymph node and lung biopsy specimens revealed non-necrotizing granulomas, indicative of sarcoidosis. Salivary gland biopsy and autoantibody testing confirmed the presence of concomitant SjD. Hormone replacement therapy markedly improved pituitary enlargement and pituitary hormone secretion, allowing the discontinuation of replacement therapy after 137 days. However, despite the improvement in pituitary and lymph node lesions, interstitial pneumonia subsequently developed due to SjD, necessitating systemic immunosuppressive therapy. In conclusion, this case demonstrates a rare overlap between sarcoidosis presenting with hypopituitarism and SjD, in which pituitary lesions improved, but immune activity progressed in other organs. Thus, immune-mediated disease activity may differ between organs in overlapping syndromes, and pituitary lesions in sarcoidosis do not necessarily parallel systemic disease activity.
SN - 1348-4540
SN - 0918-8959
ER -