Endocrine Abstracts

Introduction: Lymphocytic hypophysitis is a strange cause of hypopituitarism which can represent a difficult diagnostic and therapeutic challenge.

Objectives and methods: Describe the diagnosis, evolution and treatment of a case of lymphocytic hypophysitis in a patient who began with hypopituitarism and a year after the diagnosis had local symptoms. We reviewed the medical history of the patient from the moment the patient contacted with us to the months after the patient went surgery. It has been collected clinical, laboratory and radiological data during this period.

Results: This 51-year-old man presented with low TSH (0,122), low ft₄ values (0.45) and hypogonadotropic hypogonadism without any other pituitary alterations. His visual examination was normal. The MRI demonstrated a 15.5×10×8.5 sellar lesion, thickening in the pituitary stalk (6 mm), loss of differentiation (hyperintensity) of the neurohypophysis and heterogeneous parenchyma of the adenohypophysis. Because of the absence of symptoms in the patient, we corrected the deficits and we followed up. At 3 months after diagnosis the patient developed adrenal insufficiency so we corrected this new deficit. At 1 year after diagnosis the patient presented with severe headache and Tolosa-Hunt syndrome, so we began treatment with high dose of dexamethasone. The patient had initial improvement but relapsed after decreasing dexamethasone, so the patient was treated with trans-sphenoidal surgery with a total removal of the lesion. The patient remains asymptomatic on pituitary replacement therapy.

Conclusions: Lymphocytic hypophysitis is an uncommon cause of hypopituitarism which can present symptoms long time after the diagnosis. Due to the inflammatory changes, the patient could present headache and other local symptoms despite the absence of compression of nearby structures. In this case, if the patient does not respond to high doses of steroids, surgery is mandatory.