Lymphocytic hypophysitis (LyH) is a rare condition often associated with pregnancy (usually presenting in the last month of pregnancy or in the first two post-partum months). We describe a very rare case of recurrent LyH during two pregnancies.
A 25-years old woman presented in 7/2003 with a 6-week history of headaches and a 2-week history of visual deterioration whilst 38 weeks pregnant. Bitemporal hemianopia was confirmed and pituitary MRI revealed a sellar mass deforming the chiasm. Secondary hypothyroidism was found and levothyroxine was started. Hydrocortisone was also added. She had induction of labour two days later and she delivered a healthy boy. Two days after delivery, she had urgent transsphenoidal removal of the mass; pathology was consistent with LyH. Post-operatively, she made good recovery with marked visual improvement. Short Synacthen test was normal and she was breastfeeding. Pituitary MRI (11/2003) revealed a small amount of tissue within an enlarged fossa with no significant suprasellar extension. In 1/2004, she conceived again and at the 14th week of pregnancy she was experiencing increasingly generalised headaches and bilateral visual disturbance. MRI (3/2004) showed pituitary enlargement elevating the chiasm. She had bitemporal field defects and she was put on hydrocortisone (final dose: 30 mg am, 15 mg pm). In the subsequent weeks, she had close visual monitoring and no further deterioration was detected. In 9/2004, she delivered a healthy boy. Post-partum, her vision returned to normal and follow-up imaging showed gradual resolution of the LyH. Her periods returned and adequate ACTH reserve was confirmed. She had no further pregnancies. In her latest follow-up (12/2016), she is on levothyroxine and GH replacement.
Although, it has been suggested that a history of LyH in pregnancy does not increase the risk of developing LyH in subsequent ones, our case demonstrates the variable natural history of this condition.