Endocrine Abstracts

Background: Hypophysitis is a heterogeneous condition that leads to inflammation of the sella and/or suprasellar region, potentially resulting in hormonal deficiencies and/or mass effects. The overall incidence and prevalence of hypophysitis has dramatically increased over the past decade, mainly due to increased awareness of the condition in the medical community. The clinical presentation varies from an asymptomatic condition to a fatal disease often as a result of electrolyte abnormalities due to glucocorticoid deficiency in the context of adrenal crisis from central adrenal insufficiency. A presumptive diagnosis can be made often without biopsy. Hormone replacement and, in selected cases, careful observation is advised with imaging follow-up.

Case presentation: A 47-year-old male patient with a history of dyslipidemia and smoking habit, presented with muscle cramps, paresthesias, profound fatigue, constipation, and significant weight loss over a year. Initial diagnostic tests revealed primary hypothyroidism due to Hashimoto’s thyroiditis. Upon admission, clinical signs included low blood pressure and episodes of hypoglycemia. Laboratory findings indicated corticotropic insufficiency, gonadotropin deficiency, and normal prolactin. Cerebral MRI findings were pivotal in the diagnostic process, revealing no abnormalities in the anterior pituitary, homogeneous enhancement and a normal pituitary stalk. The diagnosis of autoimmune hypophysitis was made due to the association of anterior pituitary insufficiency and Hashimoto’s thyroiditis. Treatment was initiated promptly, incorporating levothyroxine, oral hydrocortisone, and testosterone injections. Despite the severity of the initial presentation, significant improvement was observed with no reported functional complaints.

Conclusions: Although the diagnosis of hypophysitis ultimately requires a biopsy, the presumptive diagnosis based on clinical manifestation in conjunction with magnetic resonance imaging (MRI) and laboratory findings is typically made in clinical settings. Milder forms of hypophysitis are treated with replacement of deficient hormones. Timely diagnosis and interventions are keys to prevention of the lethal complications of this disease.