Pituitary granuloma and chronic inflammation of hypophysis: Clinical and immunohistochemical studies

Abstract

We describe five patients with chronic inflammation of the hypophysis including three pituitary granulomas of unknown aetiology. In contrast to the previously reported cases, the involvement of neurohypophysis or hypothalamus was a distinct clinical feature in these patients. Impairment of anterior pituitary function was less prominent, while polyuria and polydipsia occurred in all cases. Enlargement of the sella turcica was absent in three and slight in two cases. CT scan and MR images demonstrated a contrast-enhanced sellar mass in all patients; abnormally thickened pituitary stalk and infundibulum with contrast-enhancement was observed in four. The fibrous tissues were removed by the transsphenoidal approach in four patients, and by the subfrontal approach in one case. In all patients, the endocrinological dysfunction was prolonged. No increase in the size of the remaining pituitary mass was demonstrated on repeated MR images in any of the patients. On histological examination, granulomatous formation was present in three samples, and multinucleated Langhans' giant cells were seen in one. The epithelioid cells and multinucleated giant cells constituting the granulomas were positive for anti-macrophage antibody. No firm laboratory or histological evidence was obtained supporting the presence of systemic disease leading to granulomas. In the other two cases, the pituitary lesions were composed of chronic inflammation tissue, and serum antipituitary antibodies were present in a patient with concurrent Hashimoto's thyroiditis. Our experiences with chronic inflammation of the hypophysis indicate that these patients are best managed by histological confirmation of the lesion followed by adequate hormonal replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…Histopathological findings of pituitary biopsy remain the gold standard for diagnosing primary hypophysitis. Surgery provides live tissue for histological diagnosis and can rapidly decompress the mass lesion, thereby resolving headache and visual deficits immediately [1,11,22]. Furthermore, surgery and definitive histological diagnosis may obviate the unnecessary use of high-dose steroid therapy and facilitate the appropriate treatment of other conditions such as infection or neoplasm.…”

Intrasellar Tuberculoma - A Difficult Diagnosis

“…The radiological appearance of pituitary tuberculoma is similar to that of nonsecretor adenomas or inclusive aneurysms [10,15]. Thickening of the pituitary stalk has been reported as a sign of pituitary tuberculoma [11], but this is a nonspecific finding that is also found in other inflammatory or neoplastic conditions [15,19,20]. Due to the absence of specific clinical, analytical or radiological data, the diagnosis of sellar tuberculoma is usually established after a surgical procedure; the lack of clinical suspicion about the tuberculous nature of the lesion does not allow the conservation of operative specimens to specific cultures [5].…”

“…However, there are no apparent reasons to explain this intriguing location. Previous or actual tuberculous infection elsewhere was present in 30% of patients [15].There are no clinical, analytical or radiological data to distinguish tuberculomas from other pituitary lesions such as nonsecretor adenomas and other granulomatous process of the hypophysis (sarcoidosis, syphilis, giant cell granuloma or lymphocytic hypophysitis) [16][17][18][19][20]. In our patient, diagnosis of pituitary tuberculoma was based on histological findings, a strong reaction to the tuberculin test which was previously negative and exclusion of aforementioned conditions.…”