Endocrine Abstracts

Background: Hypophysitis, an inflammatory disorder of the pituitary gland, is a rare but significant cause of hypopituitarism. It is often challenging due to its non-specific symptoms and can mimic other suprasellar pathologies. This report presents a case of idiopathic hypophysitis in a young woman, managed with medical therapy and closely monitored for clinical and radiological outcomes.

Case Presentation: A 29-year-old female presented with secondary amenorrhea of 8-month duration. Initial endocrine evaluation revealed hyperprolactinemia (1591 mIU/l), secondary hypogonadism (FSH 3.6 IU/l), preserved cortisol response to synacthen stimulation and central hypothyroidism (FT4 9.4 pmol/l, TSH 1.5 mIU/l). MRI revealed a 13x10 mm homogeneously enhancing suprasellar lesion involving the pituitary stalk, suggesting differential diagnoses of craniopharyngioma or an inflammatory aetiology like hypophysitis.

Management and Outcome: Tumor markers and serum ACE were negative, and a CT TAP excluded systemic malignancy. Following a pituitary multidisciplinary team (MDT) review, the diagnosis was deemed most consistent with idiopathic hypophysitis based on MRI findings, particularly stalk involvement extending into the third ventricle. She commenced prednisolone at 60 mg/day, which led to marked clinical and radiological improvement. One month post-steroid therapy, MRI showed a reduced lesion size (12×9 mm), with further decrease to 10x9 mm after six months. Prednisolone (60 mg/day) was started, resulting in radiological improvement. Follow-up MRI one month post-steroid therapy showed a reduction in lesion size (12×9 mm). Further imaging in 6 months demonstrated continued improvement, with the lesion now measuring 10×9 mm.

Conclusion: This case underscores the efficacy of early recognition and appropriate medical management of idiopathic hypophysitis. The favourable response to glucocorticoid therapy, evidenced by radiological improvement, supports the inflammatory nature of the condition. A structured multidisciplinary approach remains crucial for accurate diagnosis and optimal therapeutic outcomes in such cases, continued monitoring remains essential to exclude alternative diagnoses.