Endocrine Abstracts

Introduction: Lymphocytic hypophysitis is a rare clinical condition with incidence as low as 1 in 9 million cases. It occurs commonly in women during pregnancy and symptoms may continue postpartum. Often, imaging of sellar masses is not sufficient to diagnose the condition and needs undertaking of good clinical history.

Case report: 42-year-old female with history of 14 weeks postpartum admitted to emergency with c/o worsening tiredness and fatigue which lasted for few days. She has a history of vomiting associated with headaches for about 7 months. She is not able to breast feed her child and has some menstrual spotting observed a week ago. On examination, she is thin built, and fair skinned with blood pressure of 110/70 mm Hg on lying down, pulse of 75 beats/min. There is absence of skin hyperpigmentation with no associated visual field deficit. Her rest of the examination is within normal limits. Her investigations revealed morning cortisol level of 60 nmol/l with serum Na- 123 mmol/l, serum calcium- 2.7 mmol/l, serum phosphate-1.5 mmol/l, Prolactin-128 miu/l, FSH-5.6 iu/l, LH- 4 iu/l, Oestradiol- 819 pmol/l, fT3-3.2 pmol/l, fT4- 12.2 pmol/l, TSH-4.13 miu/l. She was started on IV fluids and hydrocortisone 100 mg IV stat followed by 50 mg intravenous 6^th hourly. She felt much better the next day with an improvement in her GI symptoms. Her MRI pituitary on admission revealed normal appearance of the pituitary gland.

Conclusion: Our case presented with clinical features of headaches and vomiting started towards third trimester pregnancy and continued postpartum with symptoms of isolated secondary adrenal insufficiency and normal MRI of pituitary pointing towards diagnosis of lymphocytic hypophysitis as most common cause. This is unusual as classically LH may present with radiological evidence of pituitary enlargement with or without stalk thickening.