Endocrine Abstracts

Introduction: Lymphocytic hypophysitis is a rare endocrine disease involving lymphocytic infiltration and chronic pituitary inflammation. It may result in significant morbidity by loss of pituitary functions and neurological deficits. Pituitary abscess is another rare disease which may be associated with underlying parasellar pathology. Here, we report a case of lymphocytic hypophysitis diagnosed with a pituitary abscess and recurrent suprasellar involvement after surgery.

Case: A 58-year-old female presented with headache, panhypopituitarism and a pituitary lesion with thickening of pituitary stalk. A pituitary surgery was done for definitive diagnosis and it revealed pituitary abscess associated with lymphocytic hypophysitis. Four months after antibiotherapy, the lesion recurred with extension to hypothalamus and compressive symptoms. High dose glucocorticoid treatment was initiated after exclusion of recurrent pituitary abscess with second surgery. The pituitary lesion reduced significantly in 3 months. However, the glucocorticoid treatment had to be stopped earlier due to toxic hepatitis and replaced to azathioprine.

Discussion: Lymphocytic hypophysitis may cause complete loss of vital pituitary functions and neurological deficits. The disease may rarely be complicated with abscess, therefore careful evaluation and surgical treatment should be performed in these cases. Most symptomatic LH require pulse doses of methyl-prednisolone or prednisone followed by a slow taper over a period of weeks to months. Despite good response to these first-line therapies in the majority of patients, relapses are common. In recurrent and symptomatic lymphocytic hypophysitis, high-dose glucocorticoids combined with azathioprine may be a successful choice of treatment.