Lymphocytic hypophysitis causing hypopituitarism and diabetes insipidus, and associated with autoimmune thyroiditis, in a non-pregnant woman

Abstract

Summary:A 25 year old non-pregnant woman presented with a one-year history of amenorrhoea and polyuria. Three months before her admission, she had suffered lymphocytic meningitis. Hormonal studies revealed hypopituitarism and central diabetes insipidus, with associated primary autoimmune hypothyroidism. Computed tomographic scan and magnetic resonance imaging showed a pituitary mass with suprasellar extension and thickened stalk. Transsphenoidal surgery was performed and the histological study revealed fibrosis and diffuse lymphocytic infiltration with predominance of CD4 lymphocytes. This further case of lymphocytic hypophysitis was not related to pregnancy and produced diabetes insipidus, two uncommon associations. We discuss the features that can lead to a preoperative suspicion of this rare disorder.

Lymphocytic hypophysitis presenting with diabetes insipidus: MR findings

“…Clinical features of almost normal adenohypophysial function in our cases were similar to infundibulo-neurohypophysitis and the cases of Nishioka et al [6]; however, our MR findings were similar to lymphocytic hypophysitis presenting with diabetes insipidus by Paja et al [8] and Abe et al [9].…”

“…In other reports of lymphocytic hypophysitis presenting with diabetes insipidus by Paja et al [8] and Abe et al [9], MR images show diffuse enlargement of the pituitary gland, thickening of the infundibulum and/or pituitary stalk, lack of high-intensity signal of the neurohypophysis on a T1-weighted images, and marked homogeneous enhancement of the lesion. Those cases also present clinically with hypopituitarism.…”

Empty sella and primary autoimmune hypothyroidism

“…This is sometimes associated with either other autoimmune processes, particularly those involving the thyroid [42][43][44][45][46], or autoimmune polyglandular syndrome [47].…”

Recurrent autoimmune hypophysitis successfully treated with glucocorticoids plus azathioprine: a report of three cases

“…Recent reviews indicate that AH occurs primarily in young women during pregnancy or postpartum [2,4], but it also occurs in postmenopausal women [1], non-pregnant women [9], and men [10,11,12]. In the present study, all three cases were female, one of which was postmenopausal.…”