Severe hyponatremia revealing lymphocytic hypophysitis

Abdelkader Yahi; Lachekham Aicha; Haffaf Lounes; Benabdellatif Katia; Longo Redoune; Derriche Abderrahim; Talbi A; Derradji Hakim; Ould-Kablia Samia; Bendalah Meriem

doi:10.1530/endoabs.99.EP1115

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Endocrine Abstracts (2024) 99 EP1115 | DOI: 10.1530/endoabs.99.EP1115

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Severe hyponatremia revealing lymphocytic hypophysitis

Abdelkader Yahi ¹ , Lachekham Aicha ¹ , Haffaf Lounes ¹ , Benabdellatif Katia ¹ , Longo Redoune ¹ , Derriche Abderrahim ¹ , Talbi A ¹ , Derradji Hakim ¹ , Ould-Kablia Samia ¹ & Bendalah Meriem ¹

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¹El Djazair, Endocrinology Bir Mourad Rais

Background: Hypophysitis is a rare pathology its symptoms and radiological signs are non-specificy making its diagnosis difficult

Case Description: A 62-year-old Women, mother of 5 children, with a History of type 2 diabetes mellitus, hypothyroidism. During a period of fasting, the patient presented with profound asthenia, a tendency to hypotension. A severe hyponatremia at 119 mmol/l was diagnosed. The patient received urgent treatment. The hormonal biological assessment revealed a collapsed cortisol level with a normal ACTH level confirming the corticotrope deficiency. The rest of the assessment is in favor of anterior pituitary insufficiency with gonadotrope, somatotrope and lactotrope deficiency. The hypothalamic-pituitary MRI suggests a partially empty sella turcica and a nodular thickening of the pituitary stalk of 5.5 mmy strongl, enhanced in favor of lymphocytic hypophysitis.

Discussion: Lymphocytic hypophysitis is linked to lymphocytic infiltration of the pituitary gland. Its probably autoimmune pathogenesis remains poorly understood. It can be associated with autoimmune thyroiditis or another autoimmune disease in 20% of cases. There are asymptomatic forms where the diagnosis can be made several years after the initial event. The diagnosis is sometimes made in the presence of anterior pituitary insufficiency with normal imaging or with an empty sella turcica appearance, especially in a multiparous woman. Corticotropic deficiency is the most common, and makes this disease serious due to the risk of acute adrenal insufficiency.

Conclusion: A number of clinical, biological and neuroradiological arguments may suggest the diagnosis of lymphocytic hypophysitis, but the certainty can only be histological.