Endocrine Abstracts

Case A:
A 15 year old girl was found to have a sellar mass on MR in the course of investigations for secondary amenorrhoea. Prolactin was normal at 305 milliunits per litre and random coritsol was 92 nanomols per litre. She was lost to follow up, but re-presented 2 years later with lethargy and headaches. Investigations revealed hypopituitarism with low free T4, gonadotrophins, prolactin, oestradiol, and peak cortisol of 85 nanomols per litre and undetectable GH with insulin induced hypoglycaemia. Repeat MR scan of the pituitary showed reduction in the size of the sellar mass. She was commenced on standard anterior pituitary hormone replacement therapy with marked improvement in her symptoms. Because of reduction in the sellar mass size and lack of optic chiasmal compression, a conservative approach was adopted. Serial MR scans over a 2-year period revealed reduction of the sellar mass which disappeared completely. Reassessment of anterior pituitary function showed recovery of corticotroph function (peak cortisol 607 nanomols per litre), but she continued to be deficient in thyroid, growth and sex hormones.
Case B
A 45 year old lady was referred by the ophthalmologists to the endocrine clinic because of an incidental large sellar mass discovered on head CT scanning during the course of investigating severe anterior uveitis. She was commenced on 40 mg prednisolone for her uveitis. Perimetry was normal. Thryoid functions, gonadotrophins, oestradiol and prolactin were normal. Assessing corticotroph function was not undertaken as the patient had been on high dose prednisolone for 6 weeks and continued treatment was necessary for her uveitis. ACE concentrations were normal. Follow up MR scan 6 months later was reported as showing a normal pituitary gland. She remains on a maintenance dose of prednisolone 12.5 mg daily.
The presumptive diagnosis in both cases is lymphocytic hypophysitis.