Lymphocytic hypophysitis with central diabetes insipidus and subsequent hypopituitarism masking a suprasellar germinoma in a 13-year-old girl.
METHODS
We report a case of central diabetes insipidus, hypothyroidism, and subsequent hypopituitarism due to lymphocytic hypophysitis masking a germinoma in a 13-year-old pubertal girl. Magnetic resonance revealed an enlarged pituitary gland and a mass lesion in the pituitary stalk and inferior hypothalamus. Open cranial surgery of the anterior pituitary showed active hypophysitis with lymphocytic infiltrates but without necrosis. Despite prednisolone therapy, 1 year later an enlarged, irregular cystic mass lesion had developed; in the pituitary stalk and inferior hypothalamus, a endoscopic biopsy revealed germinoma.


CONCLUSIONS
Lymphocytic hypophysitis in children may be the first sign of a host reaction to an occult germinoma. The diagnosis of central diabetes insipidus with a thickened pituitary stalk requires long-term follow-up to establish the underlying cause.
Department of Pediatrics, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Yoko
Y
Mikami-Terao
Masaharu
M
Akiyama
Takaaki
T
Yanagisawa
Junko
J
Takahashi-Fujigasaki
Kentaro
K
Yokoi
Kohei
K
Fukuoka
Mio
M
Sakuma
Ichiro
I
Miyata
Kohji
K
Fujisawa
Shizuo
S
Oi
Yoshikatsu
Y
Eto
D000293:Adolescent; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications*; D005260:Female; D018237:Germinoma / Q000150:complications* / Q000473:pathology; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology*; D008214:Lymphocytes / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D010900:Pituitary Diseases / Q000150:complications* / Q000175:diagnosis; D010903:Pituitary Gland, Anterior / Q000473:pathology