Lymphocytic hypophysitis: Its expanding features

Abstract

Lymphocytic hypophysitis is classically defined as an inflammatory disorder confined to adenohypophysis. However, it has recently been indicated that infundibuloneurohypophysitis underlies some subsets of central diabetes insipidus (DI). Therefore, lymphocytic hypophysitis can be considered a syndrome including disorders of both the anterior pituitary (lymphocytic adenohypophysitis) and the posterior pituitary (lymphocytic infundibuloneurohypophysitis). We describe a 77-yr-old woman with lymphocytic hypophysitis presenting with headache, diplopia, general malaise and appetite loss. Head magnetic resonance imaging (MRI) demonstrated pituitary swelling and dura mater thickening on the dorsum sella. Endocrinological investigations revealed both anterior and posterior pituitary dysfunction associated with primary hypothyroidism due to Hashimoto's thyroiditis. Headache and diplopia spontaneously disappeared, and anterior pituitary dysfunction, general malaise and appetite loss improved after taking 10 mg hydrocortisone daily, although ACTH hyposecretion persisted. Pituitary swelling was thereafter reduced but the dura mater thickening persisted. We suggest that this case may represent a variant of lymphocytic hypophysitis in which chronic inflammatory process involves both the anterior and the posterior pituitary gland, infundibulum, dura mater on the dorsum sella and cavernous sinus. Regarding expanding features of lymphocytic hypophysitis, it may be considered a syndrome including heterogeneous disorders, of which the pathogenesis remains to be elucidated.

Parasellar T2 Dark Sign on MR Imaging in Patients with Lymphocytic Hypophysitis

“…41 Therefore, the parasellar T2 dark sign is more suitable for LYH that infiltrates around the pituitary. Some previous studies have reported cavernous involvement in patients with LYH, 5,6,10,[42][43][44][45][46] but no studies have mentioned the parasellar T2 dark sign.…”

Lymphocytic Hypophysitis with a Long Latent Period from Onset of Central Diabetes Insipidus to Development of Pituitary Enlargement

“…There have been some recent reports of patients presenting with both anterior and poste-rior pituitary dysfunction (2, 7). Therefore, it may be appropriate to consider lymphocytic hypophysitis as a syndrome involving both the anterior and posterior pituitary (4). Differential diagnosis to differentiate lymphocytic hypophysitis from other pituitary diseases includes pituitary adenoma, sarcoidosis, tuberculosis, and granulomatous hypophysitis.…”

“…Lymphocytic hypophysitis is considered a syndrome including disorders of the anterior pituitary (lymphocytic adenohypophysitis), and the posterior pituitary (lymphocytic infundibuloneurohypophysitis). The latter usually presents with central diabetes insipidus (4). Although central diabetes insipidus may be idiopathic or secondary to a disturbance of the hypothalamic-neurohypophysial system including trauma, infection, tumors or other lesions, lymphocytic infundibuloneurohypophysitis has been suggested as the underlying cause in some cases previously labeled "idiopathic diabetes insipidus" (5).…”

Reversible impairment of the processing of proopiomelanocortin into ACTH in pituitary enlargement suspected of lymphocytic hypophysitis

“…phocytic hypophysitis is classified as follows: LAH, LINH, and panhypophysitis [14]. It may be appropriate to consider lymphocytic hypophysitis as a syndrome involving both the anterior and posterior pituitary [13]. The most unique and prominent MRI features are the pituitary stalk thickening and marked enlargement of the pituitary gland with homogeneous contrast enhancement.…”