Lymphocytic Hypophysitis: Case Report

Nassim Essabah Haraj, Samira Lezar, Fatima Louda, Siham El Aziz, Asma Chadli

Abstract


The lymphocytic hypophysitis is a rare autoimmune process; its diagnosis is difficult because of the low specificity of the clinical signs. The diagnosis is based on the association of clinical, radiological, hormonal and immunological data.

We report the case of a 43 years old female patient suffering from chronic headache with decreased visual acuity for 1 year, amenorrhea and galactorrhea, and progressive fatigue.

The complete hormonal examination showed adrenocorticotropic failure, thyrotropic deficiency, moderate hyperprolactinaemia and normal FSH.

MRI showed a nodular intrasellar mass extending to the upper border, measuring 11x11x13 mm, enhancing after contrast injection. The mass was filling the optochiasmatic space and lifting the optic chiasm. There was an associated thickening of the pituitary, which was not displaced and was still taking the contrast.

Lymphocytic hypophysitis was suspected and the patient was treated with Prednisone 1mg / kg / day (60 mg) with reduction of dosage over six months, and substitution by thyroid hormones with a dosage of about 75 μg per day.

The treatment was followed by reestablishment of menstruation and by the disappearance of headaches. The control MRI showed a reduction in the size of pituitary process.


Keywords


Lymphocytic hypophysitis, pituitary gland, hypopituitarism, autoimmunity, Magnetic Resonance Imaging.

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