Granulomatous hypophysitis in a postpartum patient: A case report

Abstract

Hypophysitis is a pituitary inflammatory disorder commonly misdiagnosed and treated as a pituitary macroadenoma. Occurring at an incidence of 1 case to 9 million people into lymphocytic, granulomatous, _histopathologically_ per year, it is further classified and xanthomatous hypophysitis. A recent report indicated that 85 cases of granulomatous hypophysitis have been reported in the literature. Mainly affecting females, the most common presenting symptoms are headaches and visual symptoms due to optical chiasm compression. Although histopathology is the sole method for definitive diagnosis, other diagnostic modalities like MRI can give some suggestive findings. Here, we present a case of a 30-year-old postpartum woman that presented to our institution for polyuria/polydispia, headaches, visual disturbances, and symptoms of hypothyroidism. Further evaluation led to the diagnosis of Lymphocytic hypophysitis that recrudesced despite treatment with corticosteroids. Consequently, she was treated with transsphenoidal surgical resection, and postoperative histopathological evaluation indicated that this is a case of granulomatous not lymphocytic hypophysitis. The patient recovered perfectly after surgery with no residual symptoms on follow-up. These findings stress on the profound similarities between both pathologies and supports the theory that they are .different phases of the same disease process rather than different diseases.

Keywords

• granulomatous hypophysitis
• lymphocytic hypophysitis
• pituitary mass
• postpartum
• autoimmune history