Idiopathic Granulomatous Hypophysitis: A Rare Cystic Lesion of the Pituitary

Çavuşoğlu, Mehtap; Elverici, Eda; Duran, Semra; Komut, Erdal; Gürecçi, Servet; Sakman, Bülent

doi:10.2169/internalmedicine.54.3342

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…3 The literature contains several case reports of GH, but they largely describe nonspecific imaging findings and do not assist in differentiation from adenomas. [4][5][6][7][8][9][10]14 In a systematic review, Hunn et al 12 examined the MR imaging findings of 51 cases of GH. Their most frequent MR imaging finding was isointense T1 lesion signal in 29.4% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…3 In terms of GH, there are scant case reports on the imaging findings, and they also overlap with those of pituitary adenomas. [4][5][6][7][8][9][10] The purpose of this study was to test our observation that diffuse enhancement within the basisphenoid marrow below the sella can distinguish GH from a pituitary adenoma, a feature that is important diagnostically because medical and surgical management differs for these conditions. 11,12…”

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confidence: 99%

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Diffuse Basisphenoid Enhancement: Possible Differentiating Feature for Granulomatous Hypophysitis

Mark

Glastonbury

2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Granulomatous hypophysitis is a rare inflammatory condition of the pituitary gland with an imaging appearance that can overlap with that of pituitary adenoma. Differentiating the two before surgical resection can have important treatment implications. The purpose of our study was to determine whether it was possible to differentiate between granulomatous hypophysitis and pituitary adenoma on the basis of diffuse enhancing infrasellar basisphenoid bone marrow. MATERIALS AND METHODS:We present 3 cases, initially thought to be pituitary adenomas, that were pathology-proved granulomatous hypophysitis. The preoperative MR images were reviewed for diffuse, enhancing infrasellar basisphenoid bone marrow. For comparison, we reviewed 100 cases of pathology-proved pituitary adenoma for the same finding. Additionally, imaging findings including the sphenoid sinus pneumatization pattern, clinical history, laboratory values, and pathology results were reviewed.RESULTS: All 3 cases of granulomatous hypophysitis had diffuse enhancing infrasellar basisphenoid bone marrow. Conversely, this was not seen in any of the 100 pituitary adenomas. The patients with granulomatous hypophysitis were all women. Two patients had idiopathic granulomatous hypophysitis, and 1 had secondary granulomatous hypophysitis with sarcoidosis. Of the 100 patients with pituitary adenomas, 67 were women. The basisphenoid pneumatization patterns was as follows: 15 (type 2), 40 (type 3), and 45 (type 4). CONCLUSIONS:We present 3 cases of granulomatous hypophysitis with diffuse enhancement of the infrasellar basisphenoid bone marrow that was not seen in our 100 cases of pituitary adenomas. This imaging feature may be valuable for suggesting a diagnosis of granulomatous hypophysitis and avoiding surgical resection of what might otherwise be misdiagnosed as a pituitary adenoma.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Diffuse Basisphenoid Enhancement: Possible Differentiating Feature for Granulomatous Hypophysitis

Mark

Glastonbury

2022

AJNR Am J Neuroradiol

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“…Sellar enhancement seen in tuberculoma differs from IGH in that it has central hypointensity with an irregularly enhancing rim, and additional tests such as an interferon gamma release assay test is needed for diagnosis [114]. Apart from aforementioned imaging findings, IGH can also appear as cystic lesions mimicking abscesses [41516]. IgG4-related hypophysitis may also appear similar to IGH.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Granulomatous Hypophysitis with Rapid Onset: A Case Report

Park

Kim

et al. 2019

Brain Tumor Res Treat

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Idiopathic granulomatous hypophysitis (IGH), a rare disease, requires differentiation from more common mass lesions of the sella such as pituitary adenoma, craniopharyngioma, Rathke's cleft cyst, or pituitary tuberculoma. IGH usually presents with an insidious onset of visual defects and headaches. On the other hand, rapid onset of neurologic and visual symptoms in an IGH patient is exceptionally rare. Here, we present a biopsy-proven case of IGH with rapid onset and satisfactory outcome after high dose steroid treatment.

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“…Histologically, hypophysitis is further divided into three pathological subtypes: xanthomatous, lymphocytic, and granulomatous. Granulomatous hypophysitis, such as sarcoidosis, is likely to be the second most common subtype and features widely distributed multinucleated giant cells, histiocytes, some forming granulomas, and variable amounts of lymphocytic infiltration and fibrosis [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Neurosarcoidosis-Induced Hypophysitis Mimicking Pituitary Macroadenoma

Ach¹,

Yahia²,

Halloul³

et al. 2023

Cureus

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Sarcoidosis is characterized by the presence of noncaseating granulomatous inflammation in the affected organs. Isolated involvement of the hypothalamic-pituitary axis in patients with sarcoidosis is rare. We report a rare case of a female patient in whom hypophysitis, mimicking a pituitary macroadenoma, resulted in pituitary transsphenoidal surgery. A female patient had been complaining of bilateral temporal headaches for over a month. Brain MRI showed a pituitary adenoma of height 16 mm, width 16 mm, and depth 12 mm. Hormonal assay showed central hypothyroidism and elevated level of prolactin. Histological examination revealed granulomatous hypophysitis. A specific search for Mycobacterium tuberculosis was negative on the pituitary tissue. After the exclusion of differential diagnoses, the combination of clinical, laboratory and radiological tests led to the diagnosis of neurosarcoidosis. This report presents an uncommon case of a pituitary localization of neurosarcoidosis mimicking a macroadenoma. Understanding the different MRI aspects of neurosarcoidosis is essential to avoid interpretive blunders that could result in an incorrect diagnosis.

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Idiopathic Granulomatous Hypophysitis: A Rare Cystic Lesion of the Pituitary

Cited by 9 publications

References 7 publications

Diffuse Basisphenoid Enhancement: Possible Differentiating Feature for Granulomatous Hypophysitis

Diffuse Basisphenoid Enhancement: Possible Differentiating Feature for Granulomatous Hypophysitis

Idiopathic Granulomatous Hypophysitis with Rapid Onset: A Case Report

Neurosarcoidosis-Induced Hypophysitis Mimicking Pituitary Macroadenoma

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