Endocrine Abstracts

Background: Granulomatous hypophysitis is an extremely rare condition, therefore, a number of these cases were initially diagnosed as adenoma and inappropriately underwent surgery. Definitive management is not yet established for granulomatous hypophysitis however improvement and resolution of symptoms were noted using oral glucocorticoids.

Clinical case: A 70 year old, Filipino, female, a diagnosed case granulomatous hypophysitis in 2012. At that time she was initially managed as a case non-functioning pituitary macroadenoma (cortisol 13.4 ug/dL (6.2–19.4 ug/dL), prolactin 11.265 ng/ml (3.6–18.9 ng/ml), TSH 0.665 uIU/ml (0.27–3.75 uIU/ml), FT4 12.900 pmol/l (8.8–33 pmol/l), LH 1.876 mIu/ml (5–20 mIU/ml), FSH 15.144 mIu/ml (5–20 mIU/ml)), until the patient underwent transphenoidal surgery and histopathological results showed presence of chronic, non-caseating granulomatous inflammation of the pituitary gland. Tests for the presence of Mycobacterium tuberculosis such as AFB stain, Mycobacterium Tuberculosis PCR/nucleic acid amplification and Silver Methenamine stain were all negative. Patient does not require hormonal therapy and was lost to follow up due to resolution of symptoms. Five years after the surgery, the patient complained recurrent headaches. Cranial MRI, showed presence of an enhancing left sellar nodule measuring 1.2×1.3×1.5 cm which is superiorly deviating the pituitary infundibulum to the right and abutting the optic chiasm. No visual field defects were noted. Hormonal tests only showed central hypothyroidism and low LH and FSH. The patient was started on oral glucocorticoids (prednisone 30 mg per day and was tapered accordingly). Symptoms completely disappeared after the medication was started. After three months of steroid therapy, cranial MRI showed complete resolution of the sellar mass.

Conclusion: Granulomatous hyophysistis is a rare chronic inflammatory disorder of the pituitary that usually imitates pituitary adenoma. Diagnosis can only be made histopathologically after biopsy or surgery. Glucocorticoids in tapering doses in this case showed complete resolution of the symptoms and the pituitary lesion as well.