Idiopathic Granulomatous Hypophysitis Presenting as Panhypopituitarism

Aim: The aim is to describe a very rare case of idiopathic granulomatous hypophysitis presenting as panhypopituitarism on the background of chronic renal failure and type 2 diabetes mellitus. The patient presented with fatigue and episodes of self-terminated hypoglycemia (while on sulfonylurea) as the sole manifestation of panhypopituitarism. The case also highlights the difficulties of identifying patients with hypophysitis in the setting of chronic renal failure. Results: We describe a middle-aged man who presented to us with the sole complaints of early morning fatigue and hypoglycemia (while on glimepiride), with a background history of type 2 diabetes and chronic renal failure. Before visiting our practice, he was repeatedly evaluated for decompensation of renal and cardiovascular disease without much success. When we saw the patient there was no obvious evidence of any endocrine disturbance, especially as the blood pressure was high without any postural drop. It was only when the patient persistently complained of an impaired quality of life due to the fatigue that we decided to chase an endocrine cause for the same. On endocrine evaluation, we diagnosed panhypopituitarism secondary to idiopathic granulomatous hypophysitis. Conclusion: Idiopathic granulomatous hypophysitis is a very rare form of inflammatory pituitary disease. Fewer than 35 cases of biopsy-proven idiopathic granulomatous hypophysitis have been reported in medical literature. This is only the third case of biopsy-proven idiopathic granulomatous hypophysitis reported from India.