Wegeners granulomatosis involving the pituitary is rare, only a few cases having been reported. Most cases, diagnosed histologically or by response to treatment affect the posterior pituitary and occur in the presence of systemic vasculitis.
A histological diagnosis of Wegeners granulomatosis was made in a 51 yr. old female in 1994 after presentation with upper respiratory tract symptoms and collapse of her nasal septum and bridge. At this time, gonadotrophins were indicative of postmenopausal status and thyroid function was normal. Remission was achieved with Azathioprine and corticosteroids on which she remains. In 2001 she was noted to have secondary hypothyroidism (fT4 4.4pmol/l, TSH 0.4mU/l). Further pituitary tests revealed FSH 0.7IU/l, LH 0.4IU/l, prolactin 17mU/l, IGF1 9.7nmol/l, urine and serum osmolality 331 and 318mOsm/kg respectively. Glucagon stimulation test confirmed GH deficiency. MRI scan of the pituitary showed an enhancing pituitary mass abutting, but not displacing, the optic chiasm and a thickened pituitary stalk. Nasal sinuses were filled with inflammatory/ granulomatous tissue. cANCA was negative.
This subject has evidence of anterior and posterior pituitary dysfunction, possibly secondary to a pituitary granuloma, presenting after several years of remission from Wegeners granulomatosis. Trans-sphenoidal biopsy is not possible due to the destroyed nasal architecture. Treatment options include conservative, craniotomy or radiotherapy.
08 - 11 Apr 2002
British Endocrine Societies