Granulomatous Hypophysitis with Meningitis and Hypopituitarism.

Abstract

We report an unusual case of granulomatous hypophysitis in which visual impairment, meningitis and hypopituitarism in a 76-year-old female were associated with radiological evidence of a pituitary mass. The sellar lesion was indistinguishable from pituitary tumor on neuroimaging studies, but the recovery of visual acuity and visual field abnormalities together with the improvement of pituitary function after steroid administration indicated that the mass lesion was due to an inflammatory disease of the pituitary gland. The pituitary tissue obtained by transsphenoidal hypophysectomy revealed granulomatous inflammatory cell infiltration with epithelioid cells and scattered multinucleated giant cells. Although a causal relationship with meningitis was not ascertained, possible exposure of the CSF space to the autoimmune inflammatory process of the pituitary gland was likely in view of the positive pituitary antibody reaction and radiological evidence of suprasellar extension. This entity should be considered when evaluating patients with a pituitary mass, hypopituitarism and meningitis.

Inflammatory Hypophysitis - The Spectrum of Disease

“…Whether these cases represent a di¤erent stage of the spectrum of the inflammatory changes seen with lymphocytic hypophysitis -with fibrous reaction being the end stage - [10] or should be considered as a separate disease [21] is controversial. However, we are in favour of including idiopathic granulomatous hypophysitis within the spectrum of lymphocytic hypophysitis for the following reasons; firstly, both lymphocytic hypophysitis and idiopathic granulomatous hypophysitis have similar ultrastructural features [1,8,9,15,18,29]. Secondly, there is evidence that both conditions share an autoimmune pathogenesis, in the case of lymphocytic hypophysitis this is well documented [5,17].…”

Primary granulomatous hypophysitis: a case report and literature review

“…Imaging appearances of the three primary hypophysitis types are very similar. The striking CT features are an intrasellar mass with cystic areas and ring enhancement [12][13][14]. Currently, MRI plays a crucial role in the diagnosis of primary hypophysitis because it has distinct advantage over CT for imaging the pituitary and sellar regional lesions.…”

Granulomatous Pachymeningitis Around the Sella Turcica (Tolosa-Hunt Syndrome) Involving the Hypophysis-Case Report-

“…10) However, radiological study clearly showed that the granulomatous lesion was outside the pituitary gland. In addition, the histological study showed that the anterior pituitary gland was not so affected compared with the posterior lobe, which correlated well with the hormonal evaluation.…”