Endocrine Abstracts

Introduction: Giant cell granulomatous hypophysitis is a rare chronic inflammatory disorder of the pituitary gland. It is generally presents with a clinic of sellar mass lesion with pituitary insufficiency. Histologically it is characterized by composites of histiocytes, plasma cells and giant cells with or without areas of necrosis. Tuberculosis is a very rare cause of secondary granulomatous hypophysitis. We report a case presented with hypopituitarism symptoms due to tuberculosis etiology and pathology revealed non-caseating giant cell granulomatous hypophysitis.

Case Report: A 51-year-old female admitted to our clinic with symptoms of mild headache and lethargy. Laboratory findings revealed TSH: 2.28 μIU/ml (normal, 0.34–5.6) fT₃: 2.08 pg/ml (normal, 2.5–3.9) fT₄: 0.56 ng/dl (normal, 0.61–1.12). The laboratory findings were suggest the central hypothyroidism. Gonadotropin levels were consistent with menopause. Basal cortisol level was found 2 μg/dl. Serum sodium and potassium levels were in normal range. Insulin tolerance test was performed for evaluation of the peak levels of cortisol and GH response. Peak GH and cortisol levels found 0.43 ng/ml and 14.75 μg/dl, respectively. Afterwards a diagnosis of pituitary hormone deficiency was made. Steroid was initially started and later on levothyroxine therapy was added. MRI showed a significant enlargement in adenohypophysis. Transsphenoidal biopsy of sella was done for the diagnosis. Pathology showed multinucleated giant cells characterised noncaseating granulomatous inflammation. Stain for acid fast bacilli and fungal etiologies were negative. The evaluation of etiology and differential diagnosis of granulomatous hypophysitis was done. Tuberculosis was diagnosed. The patient was started to receive antitubercular therapy including Pyrazinamide, Streptomycin, Isoniazid and Rifampicin for first 3 months, after that continued with Isoniazid and Rifampicin for 9 months.

Discussion: Pituitary tuberculosis should be considered in the differential diagnosis of granulomatous hypophysitis. The early and quick diagnosis is an important concern because the disease may be reversible with anti tubercular therapy.