406Lymphocytic hypophysitis is an uncommon condition, with a natural history that is not well-known. Patients usually present with chiasmal compression and varying degrees of pituitary dysfunction. We report a case of lymphocytic hypophysitis that initially presented as partial hypopituitarism. Eight years later, the patient developed symptoms of chiasmal compression.
CASE REPORTA 66-year-old woman presented eight-and-a-half years previously with bilateral leg edema and was found to have a free thyroxine level of 6 pmol/L (reference range 11-23). Despite an inappropriately normal thyroid stimulating hormone (TSH) and negative anti-microsomal antibodies she was diagnosed with primary hypothyroidism and treated with L-thyroxine. No other investigations were done. Four years later, she presented with a three-day history of vomiting and generalized weakness. She had no headaches, visual complaints, abdominal symptoms, polyuria, polydipsia or nocturia. There was no previous history of postpartum hemorrhage. She was unable to lactate after each ABSTRACT: Background: Lymphocytic hypophysitis is an autoimmune condition that commonly presents in women of childbearing age as hypopituitarism and a sellar mass. Case report: A 66-year-old woman presented with anterior pituitary dysfunction. Computed tomography imaging revealed a small hypodensity that was not felt to be the cause of the pituitary dysfunction. Eight years later, her vision rapidly deteriorated and MRI showed a pituitary mass lesion causing optic chiasm compression. Histological examination of the partially resected gland revealed evidence of lymphocytic hypophysitis. Conclusion: Our patient is an example of the variable presentation and course of lymphocytic hypophysitis. Such a long latent period between the initial presentation of adenohypophysial hypofunction and optic chiasm compression due to an enlarging pituitary mass has not been reported.
RÉSUMÉ: Période de latence prolongée avant l'apparition d'une masse pituitaire dans l'hypophysite l y m p h o c y t i q u e . I n t r o d u c t i o n :L'hypophysite lymphocytaire est une maladie auto-immune qui survient habituellement chez des femmes en âge de procréer et dont la présentation est celle d'un hypopituitarisme et d'une masse sellaire. Cas clinique: Une femme âgée de 66 ans a consulté pour une dysfonction de l'hypophyse antérieure. Huit ans plus tard, sa vision s'est détériorée rapidement et l'IRM a montré une masse pituitaire comprimant le chiasma optique. L'examen histologique de la glande partiellement réséquée a montré qu'il s'agissait d'une hypophysite lymphocytaire. Conclusion: Notre patiente est un exemple de la variabilité dans la présentation clinique et dans l'évolution de l'hypophysite lymphocytaire. Il s'agit de la première publication rapportant un cas où la période de latence entre l'apparition de la symptomatologie de l'hypofonction antéhypophysaire et celle de la compression du chiasma optique due à une masse pituitaire expansive a été aussi longue.
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