Lymphocytic hypophysitis with cystic MRI appearance

Pérez-Núñez, Ángel; Miranda, Pablo; Arrese, Ignacio; González, P.; Ramos, Ana; Lobato, R.D.

doi:10.1007/s00701-005-0641-0

Cited by 17 publications

(10 citation statements)

References 15 publications

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“…Preservation of the hyperintense bright spot of the posterior pituitary on T1-weighting depends on whether there is involvement of the posterior lobe. In the present cases, while many of the typical features were present, a large cystic component was also found, an unusual feature that has only been described in several other cases [17][18][19]. The true diagnosis may only be made histologically.…”

Section: Discussionsupporting

confidence: 64%

Lymphocytic Hypophysitis Occurring Simultaneously with a Functioning Pituitary Adenoma

et al. 2008

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Abstract. Lymphocytic Hypophysitis (LH) is a rare and previously under-recognised disorder, most commonly affecting young females in the post-partum period. It presents clinically with symptoms and signs related to either a pituitary mass or hypopituitarism, frequently mimicking a pituitary adenoma; the diagnosis of LH can only be made histologically with the presence of a dense lymphocytic infiltration usually confined to the anterior pituitary. We present two case histories of patients who presented with symptoms suggestive of a functioning pituitary adenoma who also had concomitant LH confirmed histologically. The first case was a 39 year old lady, with a history of primary hypothyroidism, who presented with weight gain and hirsutism and clinical and biochemical features of Cushing's syndrome. The second case was a 61 year old male, also with a history of primary hypothyroidism, who presented with visual field loss and biochemically with hyperprolactinaemia. In both patients, magnetic resonance (MR) imaging of the pituitary demonstrated an enlarged partially cystic pituitary mass with slight suprasellar extension. Both patients were treated surgically with transphenoidal drainage and excision and histological examination of the surgical specimens demonstrated a mixture of pathologies with fragments of adenohypophyseal tissue (staining positive for ACTH and prolactin respectively) with a dense chronic inflammatory cell infiltrate suggestive of LH in nearby normal anterior pituitary. In both cases a joint diagnosis of a functioning pituitary adenoma with LH was made. There have been only several reported cases of this combination of pathologies but LH even in isolation is becoming increasingly recognised.Key words: Lymphocytic hypophysitis, Pituitary adenoma, Prolactinoma, Cushing's disease (Endocrine Journal 55: 729-735, 2008) Case 1A 39 year old lady presented with a two year history of general lethargy, weight gain and hirsutism of the face and breasts. She had a history of hypothyroidism, assumed to be auto-immune although the general practitioner had not tested thyroid antibodies. She had complained of irregular periods since a transcervical endometrial resection for endometriosis and subsequently had commenced hormone replacement therapy because of hot flushes and sweating. She had had 2 children with no obstetric complications.On clinical examination she had a round plethoric face with hirsutism affecting the chin, cheeks and breasts with thinning of her skin. Blood pressure was 140/92 mmHg with no evidence of hypertensive retinopathy on fundoscopy. Systemic examination, including visual field testing on confrontation, was normal.

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Section: Discussionsupporting

confidence: 64%

Lymphocytic Hypophysitis Occurring Simultaneously with a Functioning Pituitary Adenoma

et al. 2008

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“…25 Cystic appearance was described in 5% of the patients with LYH. 1,8,11,12,[26][27][28][29][30][31][32][33][34] Homogeneous enhancement can also be observed in pituitary adenomas. 35 On the other hand, parasellar T2 dark sign was a characteristic finding in LYH and can contribute to distinguishing pituitary LYH from adenoma with certainty.…”

Section: Discussionmentioning

confidence: 99%

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

Nakata¹,

Sato²,

Masumoto³

et al. 2010

AJNR Am J Neuroradiol

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“…During the acute phase of lymphocytic hypophysitis, there is more uniform contrast enhancement of a sellar or suprasellar mass 7 ; however, in approximately 5% of reported cases, a cystic appearance is observed on MR imaging. [7][8][9] In these cases, the findings on MR imaging can resemble those seen during the acute stages of Sheehan syndrome. This is relevant because lymphocytic hypophysitis is more common in women and typically presents in the peripartum and postpartum periods.…”

Section: Discussionmentioning

confidence: 99%

Sequential Pituitary MR Imaging in Sheehan Syndrome: Report of 2 Cases

Kaplun

Fratila²,

Ferenczi³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We present the evolution of pituitary changes in the cases of 2 patients with Sheehan syndrome as assessed by MR imaging. Both patients had severe postpartum hemorrhage, symptoms of pituitary gland apoplexy, and hypopituitarism. Sequential MR imaging demonstrated evidence of ischemic infarct in the pituitary gland with enlargement followed by gradual shrinkage during several months, to pituitary atrophy. Clinical recognition of Sheehan syndrome (hypopituitarism resulting from postpartum pituitary gland infarction after severe hypotension secondary to massive bleeding 1 ) is often insidious, with the diagnosis being delayed for years. 2Pituitary imaging studies late in the course have revealed atrophy of the gland, resulting in a small empty sella. 3,4 Rarely, patients present with pituitary apoplexy.2 MR imaging studies have been reported in only a few cases. 5,6 We report the cases of 2 patients with Sheehan syndrome with acute presentations, in which the progression of pituitary gland changes was assessed by sequential MR imaging. Case Reports Case 1A 29-year-old woman delivered a full-term baby. The delivery was complicated by retained placenta and profuse bleeding, requiring emergent embolization of the uterine artery. Her hemoglobin level fell to 3.8 g/dL. Several hours later, the patient developed a severe headache and nausea. A routine CT study of her head showed no abnormality. Her symptoms resolved, and she was discharged from the hospital without additional work-up. She returned on day 17 postpartum with fatigue, fever, mild headache, failure to lactate, and postural syncope. Her temperature was 101.2°F, pulse 122, and a supine blood pressure of 90/48 mm Hg. Examination showed skin pallor, a cardiac flow murmur, clear lungs, and a soft abdomen. Laboratory evaluation revealed anemia, mild hyponatremia (sodium, 134 mEq/L), and abnormal pituitary function test results (Table) consistent with panhypopituitarism.MR imaging on postpartum day 26 (Fig 1) revealed a nonenhancing, minimally hypointense lesion in the pituitary gland. MR imaging 6 months postpartum (Fig 2) showed shrinkage of the pituitary gland with CSF signal intensity in the sella ("empty sella"). The pituitary infundibulum and hypothalamus appeared normal. Case 2A 21-year-old woman delivered a full-term healthy baby after labor was induced following premature rupture of membranes. During delivery, she sustained a fourth-degree perineal laceration with severe bleeding and hypotension (blood pressure, 60/30 mm Hg). Her he-

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Lymphocytic hypophysitis with cystic MRI appearance

Cited by 17 publications

References 15 publications

Lymphocytic Hypophysitis Occurring Simultaneously with a Functioning Pituitary Adenoma

Lymphocytic Hypophysitis Occurring Simultaneously with a Functioning Pituitary Adenoma

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

Sequential Pituitary MR Imaging in Sheehan Syndrome: Report of 2 Cases

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