title: Lymphocytic hypophysitis: differential diagnosis and effects of high-dose pulse steroids, followed by azathioprine, on the pituitary mass and endocrine abnormalities--report of a case and literature review.
abstract: We report on a man with a progressively increasing pituitary mass, as demonstrated by MRI. It produced neurological and ophthalmological symptoms, and, ultimately, hypopituitarism. MRI also showed enlargement of the pituitary stalk and a dural tail phenomenon. An increased titer of antipituitary antibodies (1:16) was detected in the serum. Pituitary biopsy showed autoimmune hypophysitis (AH). Neither methylprednisolone pulse therapy nor a subsequent treatment with azathioprine were successful in recovering pituitary function, or in inducing a significant reduction of the pituitary mass after an initial, transient clinical and neuroradiological improvement. Anterior pituitary function evaluation revealed persistent hypopituitarism. AH is a relatively rare condition, particularly in males, but it represents an emerging entity in the diagnostic management of pituitary masses. This case shows that response to appropriate therapy for hypophysitis may not be very favorable and confirms that diagnostic management of nonsecreting pituitary masses can be a challenge. Clinical, imaging, and laboratory findings are useful for suggesting the diagnosis, but pituitary biopsy may be necessary to confirm it.
authors.affiliation: Department of Medicine and Pharmacology - Section of Endocrinology, University of Messina, Italy. endocrinologia@unime.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Curtò
authors.forename: Maria L
authors.initials: ML
authors.lastname: Torre
authors.forename: Oana R
authors.initials: OR
authors.lastname: Cotta
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.forename: Maria R
authors.initials: MR
authors.lastname: Terreni
authors.forename: Libero
authors.initials: L
authors.lastname: Santarpia
authors.forename: Francesco
authors.initials: F
authors.lastname: Trimarchi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cannavò
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000473:pathology*; D001379:Azathioprine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008214:Lymphocytes / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010900:Pituitary Diseases / Q000188:drug therapy / Q000473:pathology*; D010902:Pituitary Gland / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine; D008775:Methylprednisolone