Neurosarcoidosis presenting as hypopituitarism and a cystic pituitary mass.
We report a young woman with clinical hypopituitarism and systemic sarcoidosis involving the lung, gastrointestinal tract, and peripheral lymph nodes. Laboratory evaluation confirmed that cortisol, thyroid indices, insulin-like growth factor 1, follicle-stimulating hormone, luteinizing hormone, and estradiol levels were low, with a normal prolactin. Magnetic resonance imaging revealed a large cystic pituitary lesion compressing the optic chiasm and exhibiting rim but not hypothalamic enhancement. The differential diagnosis included cystic macroadenoma, Rathke's cleft cyst, craniopharyngioma, and simple cyst. A transsphenoidal procedure provided decompression and diagnosis: pathology was consistent with sarcoidosis. Postoperatively, the patient's neurosarcoid disease markedly worsened, requiring hypothalamic irradiation. To our knowledge, this is the first report of intracranial sarcoidosis presenting solely as a cystic pituitary mass. An awareness of this possibility is important to prevent inappropriate neurosurgical intervention and subsequent potential exacerbation of neurosarcoidosis.
Guoth
M S
MS
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8020, USA.
Kim
J
J
de Lotbiniere
A C
AC
Brines
M L
ML
D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis*; D003560:Cysts / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis*; D007027:Hypothalamic Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging; D010900:Pituitary Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
D011241:Prednisone