Idiopathic granulomatoushypophysitis is a rare inflammatory disease which is characterized by inflammation and cellular infiltration of the pituitary gland. The infiltration may cause pituitary insufficiency, compression symptoms due to mass effect and diabetes insipidus. We report the case of a 33-year-old female patient who presenting with weakness, fatigue, amenorrhea and worsening of headaches about 3 months. The patient did not have blurring vision and polyuria-polydipsia. With these complaints, the patient was referred to neurology department and her brain magnetic resonance imaging (MRI) revealed pituitary adenoma and she was referred to neurosurgery and endocrinology departments. Patients physical examination was normal. Hormonal assessment showed anterior pituitary hormone deficiency and slightly high PRL levels. Pituitary MRI revealed 23x19 mm macrodenoma with suprasellar extention and diffuse homogeneus contrast enhancement. Pituitary mass extending up to optic chiasma but patients visual field examination was normal. Glucocorticoid and then levothyroxine treatment was started. The patients was performed transsphenoidal surgery for total resection of adenoma with glucocorticoid cover. Histopathological assessment revealed granulomatoushypophysitis. Tests for sarcoidosis, tuberculosis, histiocytosis X and other rare granulomatous diseases were proven negative. And so the patient was diagnosed as idiopathic granulomatoushypophysitis. Pituitary insufficiency persisted after the surgery and glucocorticoid, levothyroxine and estrogen-progestin replacement were continued. Diabetes insipidus did not develop for follow-up period. The last visit was in the portoperative third month, unfortunately the patient had permanent hypopituitarism and and there was an empty sella on the pituitary MRI. As a conclusion, differential diagnosis of hypophysitis from ptiuitary adenomas is very important since their treatment strategies are different. While total resection is recommended in adenoma surgery, biopsy of the pituitary mass and to reduce the compression signs if present are sufficient for hypophysitis. Because, pituitary functions may return to normal with glucocorticoid treatment or spontaneously in hypophysitis. Therefore, true interpretation of MRI findings before surgery is very important.
18 - 21 May 2019
European Society of Endocrinology