Lymphocytic hypophysitis: occurrence in two men.
Two men undergoing transsphenoidal exploration for pituitary adenoma were found to have lymphocytic hypophysitis. Both presented with frontal headaches, lethargy, and diminished libido. Laboratory investigations showed markedly depressed serum testosterone, and magnetic resonance imaging demonstrated pituitary enlargement, with optic chiasm involvement. Intraoperatively, the dura was adherent to the pituitary in each case. The resected glands were effaced by a dense lymphoplasmacytic infiltrate and fibrosis, without granulomas. Nonspecific peripheral enhancement on imaging suggested a diagnosis other than adenoma, but more experience with peripheral enhancement in lymphocytic hypophysitis is needed. The diagnosis was histological and required surgical intervention. Long-term pituitary replacement therapy is usually required.
Lee
J H
JH
Department of Pathology, George Washington University Medical Center, Washington, District of Columbia.
Laws
E R
ER
Guthrie
B L
BL
Dina
T S
TS
Nochomovitz
L E
LE
D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000328:Adult; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005355:Fibrosis; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008218:Lymphocytosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010901:Pituitary Function Tests; D010902:Pituitary Gland / Q000276:immunology / Q000473:pathology*; D010903:Pituitary Gland, Anterior / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010950:Plasma Cells / Q000473:pathology