Lymphocytic hypophysitis: Differential diagnosis and effects of high-dose pulse steroids, followed by azathioprine, on the pituitary mass and endocrine abnormalities - Report of a case and literature review

Lorenzo Curtò, Maria L. Torre, Oana R. Cotta, Marco Losa, Maria R. Terreni, Libero Santarpia, Francesco Trimarchi, Salvatore Cannavò

Research output: Contribution to journalArticle

Abstract

We report on a man with a progressively increasing pituitary mass, as demonstrated by MRI. It produced neurological and ophthalmological symptoms, and, ultimately, hypopituitarism. MRI also showed enlargement of the pituitary stalk and a dural tail phenomenon. An increased titer of antipituitary antibodies (1:16) was detected in the serum. Pituitary biopsy showed autoimmune hypophysitis (AH). Neither methylprednisolone pulse therapy nor a subsequent treatment with azathioprine were successful in recovering pituitary function, or in inducing a significant reduction of the pituitary mass after an initial, transient clinical and neuroradiological improvement. Anterior pituitary function evaluation revealed persistent hypopituitarism. AH is a relatively rare condition, particularly in males, but it represents an emerging entity in the diagnostic management of pituitary masses. This case shows that response to appropriate therapy for hypophysitis may not be very favorable and confirms that diagnostic management of nonsecreting pituitary masses can be a challenge. Clinical, imaging, and laboratory findings are useful for suggesting the diagnosis, but pituitary biopsy may be necessary to confirm it.

Original languageEnglish
Pages (from-to)126-134
Number of pages9
JournalTheScientificWorldJournal
Volume10
DOIs
Publication statusPublished - Jan 21 2010

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Keywords

  • Antipituitary antibodies
  • Autoimmune hypophysitis
  • Fibrosis
  • Magnetic resonance imaging
  • Pituitary mass

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Environmental Science(all)
  • Medicine(all)

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