Search

Hypophysitis has been histologically classified into five types: lymphocytic hypophysitis (LYH), granulomatous hypophysitis (GRH), xanthogranulomatous hypophysitis (XGH), xanthomatous hypophysitis (XH), and necrotizing hypophysitis. The present study evaluated 31 cases of hypophysitis to clarify their characteristic clinicopathologic features. The lesions were histologically classified into four groups: LYH (22 cases) including lymphocytic adenohypophysitis (LAH) (19 cases) and lymphocytic infundibuloneurohypophysitis (LINH) (3 cases), GRH (5 cases), XGH (2 cases), and XH (2 cases). In each group, the pituitary gland showed lymphocytic infiltration associated with focal or diffuse hypophysial destruction of variable severity and fibrosis. Histologic and clinical overlap among different types of hypophysitis, especially between LAH and LINH, suggest that these entities may have similar etiologic background and/or represent different stages of the same lesion. Considering the sampling sites and clinical manifestations, LAH may not usually involve the neurohypophysis, but LINH may often extend to the adenohypophysitis. A selective loss of adrenocorticotropic hormone-positive cells was seen in two patients with LAH despite only very slight lymphoplasmacytic infiltration. This suggests that there may be at least two causative mechanisms for hypopituitarism in hypophysitis: nonspecific destruction of all types of adenohypophysical cells by severe inflammation and selective destruction of specific adenohypophysial cells.

This report is of a patient with an isolated sellar tuberculoma with suprasellar extension in association with thickening of the pituitary stalk who presented with signs and symptoms of hypopituitarism. Magnetic resonance imaging showed a sellar mass with suprasellar extension associated with thickening of the pituitary stalk. Endocrinological parameters indicated hypopituitarism. The patient underwent a transsphenoidal procedure. The pathological diagnosis was of a typical structure of tuberculoma. If a pituitary tumor with suprasellar extension in association with the thickening of the pituitary stalk is suspected, the possibility of sellar tuberculoma must be considered in the differential diagnosis of nonsecreting sellar masses, even when no history of tuberculosis exists.

Inflammatory lesions of the hypophysis account for 0.5% of all symptomatic diseases of the pituitary, which include lymphocytic hypophysitis, granulomatous hypophysitis with or without specific etiology and pituitary abscess. Sellar tuberculoma is a rare type of granulomatous hypophysitis. We document a case of a postmenopausal lady who presented with galactorrhea, headache and blurring of vision. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed caseating granulomas, along with normal areas of preserved pituitary gland and a final diagnosis of tuberculous hypophysitis was made. This case is being documented due to the extremely rare involvement of the pituitary gland by granulomatous lesions such as tuberculosis and to emphasize the role of intraoperative consultation to obviate the need for radical surgery in such lesions.

A 62-year-old female presented with giant cell granulomatous hypophysitis manifesting as subacute unilateral ophthalmoplegia. Neuroimaging revealed a mass lesion expanding in the pituitary fossa. The mass was totally removed through the transsphenoidal approach. The histological diagnosis was giant cell granuloma. The oculomotor nerve paresis resolved completely 10 days after the operation. Giant cell granulomatous hypophysitis is symptomatically and radiologically indistinguishable from non-functioning pituitary adenoma, but is less likely to cause visual disturbance than pituitary adenoma. Giant cell granulomatous hypophysitis should be considered in the differential diagnosis of sellar and suprasellar lesions, particularly if oculomotor nerve paresis is observed without impaired visual field or acuity.

Lymphocytic and granulomatous hypophysitis are rare causes of anterior pituitary dysfunction, diabetes insipidus and hyperprolactinemia. The clinical, radiographic, and laboratory features of hypophysitis in two adolescent girls are presented along with a review of the medical literature. These subjects represent the youngest cases of autoimmune (lymphocytic) and granulomatous hypophysitis reported to date. While hypophysitis remains an unusual cause of pituitary dysfunction, it may also occur in early adolescence.

Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 × 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.

A 39-year-old woman presented with a 20 day history of recurrent hypoosmolar hyponatremia. Because her volume status seemed to be normal, the most suspected causes of her hyponatremia were adrenal insufficiency and hypothyroidism. Endocrinologic examination, including a combined pituitary function test, showed TSH and ACTH deficiency without GH deficiency, and hyperprolactinemia was also present. Sella MRI showed a pituitary mass, stalk thickening and loss of the normal neurohypophysial hyperintense signal on the T1 weighted image. Pathologic exam demonstrated granulomatous lesions and Langhans' multinucleated giant cells with inflammatory cell infiltration. After high dose methylprednisolone pulse therapy (1 g/day for 3 days) with subsequent prednisolone and levothyoxine replacement, there was no more recurrence of the hyponatremia. The sella MRI on the 6th month showed decreased mass size, narrowed stalk thickening and the reappearance of the normal neurohyphophysial hyperintense signal. She is currently in a good general condition and is receiving hormone replacement therapy.

A 54-year-old man with a long-lasting left-sided headache and biochemical evidence of hyperprolactinemia was found to have a large chromophobe pituitary adenoma, which concurred with a granulomatous hypophysitis. The mechanism of the inflammatory reaction is discussed and the immunohistochemical and ultrastructural findings of this hitherto undescribed combination of lesions are presented.

A 19-year-old girl with pituitary insufficiency and a large sella turcica was found to have granulomatous hypophysitis in association with a Rathke's cleft cyst. We think that the inflammatory process represents a foreign body reaction to leakage of cyst contents, with destruction of pituitary tissue.

A case of hypopituitarism and minimal sellar enlargement was found at hypophysectomy to have a giant cell granuloma of the pituitary. The clinical and histopathological features of this rare entity are reviewed. It is proposed that hypopituitarism which is out of proportion to minimal sellar enlargement may be a suggestive clue to the preoperative diagnosis of giant cell granulous which normally simulates a pituitary tumour.