Granulomatous hypophysistis associated with rathke's cleft cyst: a case report.
OBJECTIVE
The value of surgical intervention in the management of hypophysitis remains controversial.


METHODS
We describe a 57-year-old man presenting with general fatigue persisting for three months. Endocrine examination revealed hypopituitarism and diabetes insipidus. Magnetic resonance (MR) imaging showed a dumbbell-shaped pituitary mass lesion without a cystic component. We partially removed the lesion via a transsphenoidal approach. Histological examination yielded the diagnosis of granulomatous hypophysitis associated with Rathke's cleft cyst. No deterioration of pituitary function was observed postoperatively. Twenty months after the surgery, the lesion has spontaneously regressed on MR imaging, and he is doing well with continuing replacement therapy of hydrocortisone, levothyroxine and desmopressin acetate.


CONCLUSIONS
The diagnosis of hypophysitis, apart from typical lymphocytic hypophysitis, is difficult even with a surgical biopsy. Because a small specimen may lead to a diagnosis of non-specific hypophysitis, partial removal of the lesion is less invasive and recommended for preservation of the pituitary function.
Department of Neurosurgery, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan.
M
M
Murakami
H
H
Nishioka
H
H
Izawa
Y
Y
Ikeda
J
J
Haraoka
D020863:Central Nervous System Cysts / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003919:Diabetes Insipidus / Q000209:etiology; D003937:Diagnosis, Differential; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D007249:Inflammation / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D038361:Neuronavigation; D010900:Pituitary Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery; D014057:Tomography, X-Ray Computed