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Fulltext Granulomatous hypophysitis: a case of severe headache

Wan Muhamad Hatta SF, Hamdan MF, Md Ali SA, Abdul Ghani R

BMJ Case Rep, 2016 Sep 09;2016.
PMID: 27613264 DOI: 10.1136/bcr-2016-216395

Idiopathic granulomatous hypophysitis (GH) is an uncommon inflammatory disease of the pituitary with impairment of pituitary gland function due to infiltration by lymphocytes, plasma cells and macrophages. We report the case of a 39-year-old woman who presented with worsening of headaches for 1 month and blurring of vision over 5 days. An MRI revealed a homogeneous supra-sellar mass evoking a pituitary tumour with bulky pituitary stalk extending into the left and right cavernous sinuses. Hormonal investigations showed anterior pituitary hormone deficiencies; meanwhile histopathological examination revealed an aspect of hypophysitis. Clinical and radiological remission occurred immediately postglucocorticoid therapy with the addition of a steroid-sparing agent later in view of recurrence of symptoms on glucocorticoid dose reduction. GH has important diagnostic and therapeutic implications, as clinical and radiological features ameliorate via medical treatment. With further understanding and recognition of the disease, we hope to highlight a case of GH, in which signs and symptoms improved after initiation of corticosteroids.

Matched MeSH terms: Hypophysitis/complications; Hypophysitis/diagnosis*; Hypophysitis/drug therapy; Hypophysitis/pathology
Now You See, Now You Don't: A Case Of Spontaneous Regression of Pituitary Tumour

Jaafar AS, Mohd Shokri SS, Paramasvaran S, Palaniandy K, Fadzil F

Cureus, 2020 Jul 14;12(7):e9174.
PMID: 32802610 DOI: 10.7759/cureus.9174

Spontaneous regression of pituitary tumours are rare and can be due to tumour ischaemia, pituitary apoplexy, or lymphocytic hypophysitis. We report a case of a 32-year-old female, who presented with symptoms and signs of extrasellar pituitary enlargement and hypothyroidism. MRI revealed a pituitary mass that spontaneously regressed after a month, with complete resolution of symptoms. Not all pituitary tumours require surgical intervention especially in the case of autoimmune lymphocytic hypophysitis.

Matched MeSH terms: Autoimmune Hypophysitis
Fulltext Xanthomatous Hypophysitis Presenting in an Adolescent Girl: A Long-Term Follow-Up of a Rare Case and Review of the Literature

Wong JSL, Nasruddin AB, Selveindran NM, Latif KA, Kassim F, Nair SB, et al.

AACE Clin Case Rep, 2021 02 01;7(3):220-225.
PMID: 34095493 DOI: 10.1016/j.aace.2021.01.008

Objective: Primary hypophysitis refers to the isolated inflammation of the pituitary gland not associated with other secondary causes. Among its histopathologic subtypes, xanthomatous is the rarest.
Methods: We describe a 22-year-old woman with xanthomatous hypophysitis (XH), its clinical progression over 8 years as well as the treatment effects of prednisolone and azathioprine. Our patient was first referred for severe short stature and delayed puberty at the age of 14 years.
Results: Investigations revealed multiple pituitary deficiencies. Magnetic resonance imaging showed a pituitary mass whereby a partial resection was performed. A full resection was not feasible due to the location of the mass. The histopathologic analysis of the tissue was consistent with XH. The results of secondary workout for neoplasm, infection, autoimmune, and inflammatory disorders were negative. After surgery, a progressive enlargement of the mass was observed. Two courses of prednisolone were administered with a significant reduction in the mass size. Azathioprine was added due to the unsustained effects of prednisolone when tapered off and the concern of steroid toxicity with continued use. No further increase in the mass size was noted after 6 months on azathioprine.
Conclusion: Glucocorticoid and immunotherapy are treatment options for XH; however, more cases are needed to better understand its pathogenesis and clinical progression.

Matched MeSH terms: Hypophysitis
Fulltext 'Houdini's Pituitary:' A Case Report of Regression of Pituitary Mass to Empty Sella in a 58-Year-Old Man with Autoimmune Hypophysitis

Ooi CP, Kamarruddin NA, Mustafa N, Kew TY

J ASEAN Fed Endocr Soc, 2018;33(1):69-73.
PMID: 33442114 DOI: 10.15605/jafes.033.01.12

A 58-year-old male presented with persistent severe headache, lethargy, decline libido and no neurological deficits. Besides quadruple anterior pituitary hormonal deficiencies, magnetic resonance imaging (MRI) demonstrated an enlarged ring-enhanced non-homogenous pituitary. Following hormonal replacement, these symptoms improved but empty sella evolved. The challenges of diagnosis and management were discussed. Awareness of the unclear etiology and uncertain clinical course of autoimmune hypophysitis in a man in this age group is essential for prompt and appropriate management.

Matched MeSH terms: Autoimmune Hypophysitis