Endocrine Abstracts

Introduction: Hypophysitis is the inflammation of the pituitary gland, characterised by hypopituitarism and pituitary enlargement. It can occur as primary (commonly lymphocytic, granulomatous or xanthomatous) or secondary to systemic disease, immunotherapy or sella-based pathologies.

Case Presentation: A 30-year-old female was admitted to hospital with headache, fatigue, low mood and blurred vision, 3 months after having an emergency Caesarean section. Her initial bloods showed cortisol level <28 nmol/l, TSH <0.05mIU/l (0.3-5.5mIU/l), fT3-7.3 pmol/l (3.1-6.8 pmol/l), fT4-15.3 pmol/l (12-22 pmol/l), sodium 151mmol/l (133-146mmol/l). On further history taking, she complained of polyuria and polydipsia. Pituitary screen reported as ACTH <5pg/mL(10-60pg/mL), prolactin-2934mIU/l (102-496mIU/l), LH <0.5IU/l, FSH <0.5IU/l, oestradiol <50 pmol/l, IGF1 21.3nmol/l (10.2-40.7nmol/l). MRI showed avidly enhancing thickening of the pituitary infundibulum and absence of the posterior pituitary bright spot suggesting hypophysitis. Serum/urine osmolality and a water deprivation test were suggestive of cranial diabetes Insipidus. Blood tests, a Bone scan and a CT scan of the chest/abdomen showed no evidence of systemic causes of hypophysitis. Her case was discussed in the regional pituitary MDT and she was diagnosed with post-partum hypophysitis, partial hypopituitarism and cranial diabetes Insipidus. She was discharged with oral replacement dose hydrocortisone and desmopressin with plans to observe her carefully in the outpatient clinic. One month later, during follow-up, she reported worsening symptoms. Repeat MRI scan showed increasing size of the enhancing pituitary lesion involving the optic chiasm, hypothalamus and pituitary infundibulum. She was reviewed by ophthalmology and her case was rediscussed in the pituitary MDT and where her diagnosis of hypophysitis remained unchanged. She responded well to high-dose prednisolone, an oestrogen patch and levothyroxine to treat secondary hypogonadism and hypothyroidism.

Conclusion: Hypophysitis is a rare disease with non-specific clinical, pathological and radiological presentations. MDT approach is the key in diagnosis and management of hypophysitis patients.