title: Xanthomatous hypophysitis associated with autoimmune disease in an elderly patient: A rare case report.
abstract: BACKGROUND
  Xanthomatous hypophysitis (XH) is an extremely rare form of primary hypophysitis characterized by infiltration of the pituitary gland by mixed types of inflammatory cells, including foamy cells, plasma cells, and small mature lymphocytes. XH manifests as varying degrees of hypopituitarism. Although several previous reports have denied a possible contribution of autoimmune mechanism, the exact pathogenesis of XH remains unclear.
  
  
  METHODS
  We describe the case of a 72-year-old woman with a history of rheumatoid arthritis and Sjögren's syndrome who presented with panhypopituitarism and diabetes insipidus. At the time of her visit, she also experienced relapsed rheumatoid arthritis and Sjögren's syndrome, manifesting as arthralgia. Magnetic resonance imaging (MRI) showed a multicystic mass in the sellar and suprasellar regions. In the course of steroid replacement therapy for hypocortisolism, the patient's arthralgia diminished, and MRI revealed shrinkage of the mass. XH was diagnosed histologically following a transsphenoidal endoscopic biopsy, and it was the oldest case of XH.
  
  
  CONCLUSIONS
  To the best of our knowledge, this patient is the oldest of reported patients diagnosed with XH. Steroid therapy may be effective to XH temporarily. XH should be considered when diagnosing pituitary cystic lesions in elderly patients with autoimmune disease.
authors: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Masahiro
authors: M
authors: Oishi
authors: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Yasuhiko
authors: Y
authors: Hayashi
authors: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Issei
authors: I
authors: Fukui
authors: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Daisuke
authors: D
authors: Kita
authors: Department of Neurosurgery, Toyama City Hospital, Toyama, Japan.
authors: Tadao
authors: T
authors: Miyamori
authors: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors: Mitsutoshi
authors: M
authors: Nakada
keywords: Autoimmune disease; hypopituitarism; xanthomatous hypophysitis