Endocrine Abstracts

JOINT3374

Introduction: Hypophysitis, an inflammation of the pituitary gland, is a rare condition that can be caused by infections, autoimmune disorders, or tumors. When complicated by sphenoiditis, it poses diagnostic and therapeutic challenges. This case report describes a 51-year-old male patient diagnosed with sphenoiditis complicated by infectious hypophysitis.

Case Presentation: A 51-year-old man, with no significant past medical history, presented with a complaint of persistent headaches, fatigue, somnolence, and rhinorrhea. These symptoms prompted him to seek consultation with the ear, nose, and throat(ENT) department. Upon examination, imaging was performed, including facial MRI and pituitary sections. The MRI revealed bilateral sphenoiditis. Additionally, there wasan evidence of hypophysitis with pituitary enlargement and an 18mm intrasellar collection. These findings were indicative of an infectious process affecting both the sphenoid sinus and the pituitary gland. The patient was immediately started on intravenous antibiotic therapy for 15 days. Biological assessments revealed anterior pituitary dysfunction: Specifically, the cortisol level was markedly low (2ug/dl), consistent with corticotropic insufficiency, and low FT4 levels (0,67 ng/dl) and a normal TSH level (1,3 mUI/l), consistent with thyrotropic insufficiency. The patient was placed on corticosteroid and thyroid hormone replacement therapy. There were no complaints of erectile dysfunction or libido reduction. Prolactin and testosterone levels were within normal limits The patient showed marked improvement, with complete resolution of headaches, asthenia, and somnolence. A follow-up MRI at three months confirmed the resolution of sphenoid sinusitis and the disappearance of the intrasellar mucocele. No additional complications were observed.

Conclusion: This case highlights the rare and complex link between infectious sphenoiditis and hypophysitis, leading to anterior pituitary insufficiency. Early diagnosis and prompt management, including targeted antimicrobial therapy and hormone replacement, are crucial for optimal outcomes. Clinicians should remain vigilant for pituitary involvement in patients with sinusitis and hormonal imbalances, especially when other causes of pituitary dysfunction are absent.