Figure 1. A. Contrast-enhanced coronal computed tomography (CT) of the head displaying an enlarged pituitary gland and stalk. An aneurysm of the right internal carotid artery is suspected. B. Contrast-enhanced sagittal CT of the head displaying an enlargement of the pituitary gland and stalk.

From: Usefulness of Serum IgG4 and Thyroid Stimulating Hormone Levels in Differentiating Headache

Figure 2. A. Hematoxylin-eosin staining of the gallbladder wall. Collagen fibers are stained pink and display growth. Significant infiltration of the lymphoplasmacytic cells. B. Immunoglobulin G4 (IgG4)-positive immunohistochemical image of the gallbladder wall. Infiltration of IgG4-positive plasma cells (stained brown) is observed. More than 40% of IgG-positive plasma cells were IgG4-positive, and these cells are >10 cells/high-power field.

From: Usefulness of Serum IgG4 and Thyroid Stimulating Hormone Levels in Differentiating Headache

Figure 3. Magnetic resonance angiography of the head displaying an aneurysm (yellow dot) of the right internal carotid artery.

From: Usefulness of Serum IgG4 and Thyroid Stimulating Hormone Levels in Differentiating Headache

Figure 4. Clinical course of the patient. 25 μg/day of levothyroxin administration has been started since X + 4 years. The serum adrenocorticotropic hormone (ACTH) level was less than 2.0 pg/mL (N: 7.2-63.3) and the serum growth hormone (GH) level was 0.34 ng/mL (N: ≥2.47). In addition, the free T4 (FT4) level was 0.69 ng/dL (N: 0.7-1.7). A comparison of head computed tomography scans at X + 4 and X + 6 years suggested that prednisolone reduced the approximate pituitary volume by approximately one-half (1563 vs. 839 mm3).

From: Usefulness of Serum IgG4 and Thyroid Stimulating Hormone Levels in Differentiating Headache

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