Introduction: Hypophysitis is a chronic inflammatory condition of the pituitary gland which typically presents with hypopituitarism and a pituitary mass. The disease is rare, with an estimated incidence of 1/9000000. Most reported cases are in women during peripartum period and only approximately 15% of reported cases occur in males.
Case report: Male patient, aged 57, smoker, with a history of hypertension, just returned from India, presented with anorexia, important asthenia, somnolence, weight loss (5 kg in 2 months), decreased blood pressure (110/80 mmHg without treatment), and fever. Investigations for a parasitosis were negative and the ultrasonographical detection of a nodular goiter determined an endocrinologic consultation. The diagnosis of secondary hypothyroidism (TSH=0.102 μIU/ml, fT4=0.558 ng/dl) together with the clinical picture raised the supposition of a pituitary insufficiency, confirmed by the multiple hormonal deficiency: FSH=1.22 mIU/ml, LH=0.477 mIU/ml, testosterone <0.026 ng/ml; morning cortisol <1 μg/dl with low ACTH (19.7 pg/ml); IGF1=80.3 ng/ml (81225 ng/ml). Pituitary MRI detected a globular, convex and inhomogeneous aspect of the pituitary gland, with increased dimensions: 9.7/17.9 mm and normal sellar floor, suggestive for hypophysitis. Corticotherapy was started with rapid improvement (clinical and biological in 1 month and imagistic in 2 months).
Discussions: Lymphocytic hypophysitis is a rare disease, especially in men. Secondary adrenal insufficiency is one of the earliest manifestations and can become life threatening. Although spontaneous remission is possible, in these cases, as it was in our patient, treatment is preferable. The rapid good evolution sustained the diagnosis which can often be made on the basic clinical, biological and imagistic features, pituitary biopsy not being always necessary for effective management of the disease.