Idiopathic granulomatous hypophysitis: clinical and imaging features

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.…”

“…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. The MRI findings of primary hypophsitis include: (1) Diffuse, ill-defined, symmetrical enlargement of pituitary tissue; (2) Pituitary stalk thickened, but not deviated or unidentifiable; (3) Sellar floor usually intact; (4) Mostly isointensity with gray matter on T1 weighted image, marked homogeneous or heterogeneous enhancement by gadolinium and a strip of enhanced tissue along the dura mater (the so-called 'dural tail'); (5) Delayed complete contrast enhancement of the whole pituitary in dynamic MRI (>90 sec) [1,4,[8][9][10][11][12][29][30][31][32]. Among these unusual MRI scan findings, three imaging signs -pituitary diffuse enlargement and marked enhancement and pituitary stalk thickening, are perhaps the strongest predictor of primary hypophysitis.…”

Idiopathic Granulomatous Hypophysitis: A Rare Cystic Lesion of the Pituitary

“…Significant contrast enhancement was noted in two cases and central low density was detected in one case. Meanwhile, Pamir et al (7) reported heterogeneous hypertrophy of the pituitary gland with an irregular high signal on T2-weighted images in their two cases, and Vasile et al (8) documented heterogeneous contrast enhancement and cavernous sinus involvement. In the report of three GH cases by Gazio!lu et al (4), suprasellar extension was present and the pituitary stalk was not distinguished from the mass.…”

Granulomatous hypophysitis: two case reports and literature review

“…Usually the gland shows a diffusive heterogeneous enhancement. Typically, the lesion appears to be an enlarged and enhanced sellar mass with pituitary stalk enlargement on expanding pituitary fossa, extending into the suprasellar area with a tongue shape and compressing optic chiasm, sometimes invading into the bilateral cavernous sinus (Unlu et al, 2006;Vasile et al, 1997). Some authors also noted the appearance of mucosal thickening in the bilateral sphenoid sinus (Goyal et al, 2000) in GRH cases, but marked and homogeneous contrast enhancement of the pituitary gland was treated as a characteristic of LYH (Yamagami et al, 2003).…”

“…A thickened stalk can be defined as the most characteristic feature on sagittal or coronal magnetic resonance imaging (MRI). However, these typical radiological indications occur infrequently (Unlu et al, 2006;Vasile et al, 1997), which results in the difficulty in differentiating GRH from pituitary adenoma based upon preoperative clinical and imaging data. Therefore, a considerable number of GRH cases were initially misdiagnosed as adenoma and then inappropriately received surgery therapy (Bhansali et al, 2004).…”