Pituitary lesions: Pituitary adenomas and what else?
I. Vourliotaki, A. Boumpaki, S. Alexaki & K. Stamataki
Introduction: Pituitary lesions are quite often in the general population and can be symptomatic or not. Most are attributed to pituitary adenomas. Differential diagnosis also includes other causes, such as granulomatous diseases (sarcoidosis, histiocyttosis). Neurosarcoidosis is rare. Sarcoidosis pituitary infiltration is even more rare and usually reported in multifocal forms of the disease.
Case report: We describe a 34-year old female with headache and oligomenorrhea.
MRI showed a pituitary lesion 1.5 cm and normal pituitary stalk.
Pituitary hormone profile was normal, except for mild hyperprolactinaemia, with no diabetes insipidus.
The lesion was considered to be a non functional pituitary adenoma and the patient underwent trans-sphenoidal excision of the lesion.
Histologic examination showed a granulomatous inflamatous mass, negative for tuberculosis. Three months later no mass was found in pituitary MRI.
The patient was referred to a rheumatologist, but was lost to follow up for personnal reasons.
One year later, the patient had an MRI showing a new pituitary lesion 1.3 cm with mild hyperprolactinaemia. She was investigated for sarcoidosis but no systematic disease was found. Considering diagnosis of sarcoidosis, prednizolone was prescribed. Being on prednizolone for three months reduced size lesion to 0.9 cm. Six months later it disappeared. This confirmed diagnosis of sarcoidosis.
She received prednisolone for 18 months in total. Afterwards, she was lost to follow up again for 6 years, off corticosteroids, and recently came back with recurrence of the lesion.
She is again administered prednisolone.
Investigation for systematic disease is still negative.
Conclusion: To our knowledge, there is no other reported case of neurosarcoidosis with unique infiltration of the pituitary that persists for 6 years with no other systemic disease.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.