A complicated case of primary hypophysitis with bilateral intracavernous carotid artery occlusion

Katsiveli, Pinelopi; Sfakiotaki, Maria; Voulgaris, N.; Papanastasiou, Labrini; Kounadi, Theodora; Lymperopoulos, Konstantinos; Piaditis, George

doi:10.14310/horm.2002.1657

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…In recent years, the application of MRI in the sellar region has contributed to the feasibility of clinical diagnosis[ 8 ] and has become the preferred modality for the study of pituitary lesions. Typical MRI of LYH shows symmetrical enlargement of the pituitary gland with suprasellar extension with marked homogeneous enhancement, thickening of the pituitary stalk without deviation, disappearance of the bright spot of the pituitary gland in the T1 sequence, and the dural tail sign[ 20 , 27 - 30 ]. A lingual suprasellar and retrosellar extension of the saddle mass in contact with the basal hypothalamus and even infiltration of the basal hypothalamus is a relatively typical finding in granulomatous pituitary inflammation[ 20 ], but this feature was not present in our patient.…”

Section: Discussionmentioning

confidence: 99%

Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report

Yang¹,

Cai²,

Wang³

et al. 2022

WJCC

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BACKGROUND Lymphocytic hypophysitis (LYH) is an important condition to consider in the differential diagnosis of patients with a pituitary mass. The main clinical manifestations of LYH include headache, symptoms related to sellar compression, hypopituitarism, diabetes insipidus and hyperprolactinemia. Headache, which is a frequent complaint of patients with LYH, is thought to be related to the occupying effect of the pituitary mass and is rapidly resolved with a good outcome after timely and adequate glucocorticoid treatment or surgery. CASE SUMMARY Here, we report a patient with LYH whose initial symptom was headache and whose pituitary function assessment showed the presence of secondary hypoadrenalism, central hypothyroidism and hypogonadotropic hypogonadism. Pituitary magnetic resonance imaging showed symmetrical enlargement of the pituitary gland with suprasellar extension in a dumbbell shape with significant homogeneous enhancement after gadolinium enhancement. The size of the gland was approximately 17.7 mm × 14.3 mm × 13.8 mm. The pituitary stalk was thickened without deviation, and there was an elevation of the optimal crossing. The lesion grew bilaterally toward the cavernous sinuses, and the parasternal dural caudal sign was visible. The patient presented with repeatedly worsening and prolonged headaches three times even though the hypopituitarism had fully resolved after glucocorticoid treatment during this course. CONCLUSION This rare headache regression suggests that patients with chronic headaches should also be alerted to the possibility of LYH.

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Section: Discussionmentioning

confidence: 99%

Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report

Yang¹,

Cai²,

Wang³

et al. 2022

WJCC

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“…Changed to high-dose methylprednisolone followed by prednisolone and azathioprine for all cases Lymphocytic infiltration in pituitary tissue in case 1 No other histopathology Complete resolution on MRI with endocrine recovery in case 1 and 3 and permanent hypopituitarism in case 2 Katsivali et al . [ 26 ] 48-year-old female with headache, muscle weakness, and occlusion of both internal carotid arteries Relapse when prednisolone tapering Due to adverse effects, treatment was changed to azathioprine Clinically suspected AH No histopathology Complete resolution and restored pituitary function Curto et al . [ 27 ] 38-year-old male with diplopia, ophthalmoplegia, and headache Initial response on high-dose methylprednisolone.…”

Section: Discussionmentioning

confidence: 99%

Recurrent autoimmune hypophysitis treated with rituximab: a case report

et al. 2021

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Background Autoimmune hypophysitis is a rare condition that often results in enlargement of the pituitary gland and hypopituitarism due to inflammatory infiltration. Management of autoimmune hypophysitis can include long-term hormonal replacement and close control of the inflammatory pituitary mass. Mass-related symptoms in patients with autoimmune hypophysitis are treated with anti-inflammatory therapy, surgery, and/or radiotherapy. Case presentation We present a 25-year-old White man with visual field defects of the right eye, headache, and weight loss. Magnetic resonance imaging showed a sellar mass, and the patient underwent transcranial surgery. Histopathology revealed autoimmune hypophysitis with predominantly CD20 positive B-cell infiltration. Progression of visual field defects necessitated postoperatively anti-inflammatory treatment with prednisolone. Azathioprine was initiated under gradual tapering of prednisolone with stable conditions at first, but relapse followed after dose reduction. Therefore, rituximab treatment was initiated, which resulted in regression of the pituitary mass. Rituximab treatment was discontinued after 25 months. The patient has continuously been in remission for 4 years after rituximab treatment was stopped. Conclusion This case illustrates that rituximab might be an effective alternative treatment in B-cell predominant autoimmune hypophysitis.

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Methylprednisolone

2016

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A complicated case of primary hypophysitis with bilateral intracavernous carotid artery occlusion

Abstract: AbstrAct

Cited by 3 publications

References 19 publications

Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report

Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report

Recurrent autoimmune hypophysitis treated with rituximab: a case report

Methylprednisolone

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