Granulomatous hypophysitis: a case of severe headache

Abstract

Idiopathic granulomatous hypophysitis (GH) is an uncommon inflammatory disease of the pituitary with impairment of pituitary gland function due to infiltration by lymphocytes, plasma cells and macrophages. We report the case of a 39-year-old woman who presented with worsening of headaches for 1 month and blurring of vision over 5 days. An MRI revealed a homogeneous supra-sellar mass evoking a pituitary tumour with bulky pituitary stalk extending into the left and right cavernous sinuses. Hormonal investigations showed anterior pituitary hormone deficiencies; meanwhile histopathological examination revealed an aspect of hypophysitis. Clinical and radiological remission occurred immediately postglucocorticoid therapy with the addition of a steroid-sparing agent later in view of recurrence of symptoms on glucocorticoid dose reduction. GH has important diagnostic and therapeutic implications, as clinical and radiological features ameliorate via medical treatment. With further understanding and recognition of the disease, we hope to highlight a case of GH, in which signs and symptoms improved after initiation of corticosteroids.

Idiopathic Granulomatous Hypophysitis with Rapid Onset: A Case Report

“…However, intraoperative pituitary stalk injury led to permanent steroid replacement in 67% of patients, and rendered 4 out of 6 patients thyroxine-deficient [21]. On the other hands, recent case reports culminated in the alleviation of neurologic symptoms after corticosteroid use, and more studies favored corticosteroid treatment over excisional strategy alone (Table 1) [181922]. Corticosteroid replacement in our patient unmasked diabetes insipidus and led to resolution of neurological symptoms.…”

“…Treatment options of primary hypophysitis include the administration of corticosteroid, surgical excision, and radiosurgery [1718]. The goal of treatment is to alleviate symptoms via hormone replacement and to decompress neurovascular structures [19]. Overall, the symptom resolution was achieved in 80% of IGH patients [4].…”

A case of pituitary gland abscess associated with granulomatous hypophysitis

“…Treatment options for primary hypophysitis consist of the administration of corticosteroids, surgical excision, and radiosurgery [ 14 , 15 ]. Treatment aims to relieve symptoms [ 16 ]. Overall, the symptoms were cured in 80% of granulomatous hypophysitis patients [ 8 ].…”

“…There is only a case report of granulomatous hypophysitis reporting that prednisolone was ineffective [ 17 ]. On the other hand, recent case reports have documented a reduction in neurological symptoms following corticosteroid use, and many studies have advocated corticosteroid treatment over an excisional strategy alone [ 15 , 16 , 18 ].…”