Pituitary sarcoidosis with disappearing mass: case report
C Oxynos, C Rajeswaran & PE Belchetz
A 37 year old Afro-Caribbean woman, with panhypopituitarism secondary to a pituitary macroadenoma was referred from a DGH physician to the neurosurgeons. She complained of headaches and blurred vision. Initial presentation was with malaise, weight loss, vomiting, abdominal pain, and secondary amenorrhoea. She was found to have panhypopituitarism and was on thyroxine and hydrocortisone replacement therapy. Abdominal CT had showed widespread axillary para aortic and iliac lymphadenopathy. MRI pituitary showed a pituitary macroadenoma with extension into the optic chiasma. Pre operatively there was no deficit on Goldman visual field testing. Prolactin was 861 mu/L. At transsphenoidal surgery, the pituitary gland was found to be diffusely enlarged with marked adherence to the dura and no soft tumour was present. Pituitary biopsy showed granuloma with multinucleated foreign body type giant cells and scattered lymphocytic infiltrate. Post operative MRI showed total disappearance of the pituitary mass. SACE was 234 iu/L (50-125) and Ca-adjusted was 2.64 mmol/L. CXR was normal. CT thorax has been requested. She subsequently developed DI and was treated with nasal desmopressin and was also started on HRT for hot flushes. (FSH and LH less than 0.3 iu/L, Oestradiol less than 50 pmol/L). Neurosarcoidosis is seen in approximately 5% of patients with sarcoidosis with pituitary and hypothalamic involvement in only 0.5% of cases. Our working diagnosis in our patient is panhypopituitarism secondary to sarcoidosis with spontaneous resolution of the pituitary mass, but no hormonal improvement.