title: Sellar Wegener Granulomatosis Masquerading as Cabergoline-Resistant Prolactinoma.
abstract: BACKGROUND
  Pituitary manifestation of Wegener granulomatosis (WG) is extremely rare. When there is pituitary involvement, the granulomatous inflammatory lesions involving the pituitary gland may appear several months to years after the primary diagnosis.
  
  
  METHODS
  We present a case of a 32-year-old woman who presented with galactorrhea, amenorrhea, and elevated serum prolactin levels. Imaging demonstrated a sellar lesion with characteristics of a pituitary macroadenoma. Treatment with cabergoline was initiated, but the tumor continued to grow during a 6-month period. Subsequent surgical exploration revealed a chronic inflammatory lesion; the patient subsequently was diagnosed with WG based on laboratory evaluation and further systemic manifestations. She had a favorable clinical and radiologic response with immunosuppressive doses of glucocorticoids and rituximab.
  
  
  CONCLUSIONS
  This case appears to be the first reported of a patient with unknown WG in whom the diagnosis was established after she presented with a sellar lesion mimicking a prolactin-secreting pituitary adenoma on initial presentation requiring surgical resection. The only endocrine abnormality discovered was moderate hyperprolactinemia. Sellar lesions with only moderate elevations in serum prolactin, particularly those that are refractory to medical management with a dopamine agonist, should prompt further investigation to confirm the diagnosis. WG should be part of the differential diagnosis of inflammatory lesions in the sella, the identification of which can facilitate early diagnosis and treatment of this systemic disease for optimal outcome.
authors: Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors: Ilyas M
authors: IM
authors: Eli
authors: Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
authors: Amol
authors: A
authors: Raheja
authors: Department of Internal Medicine, Division of Endocrinology, University of Utah, Salt Lake City, Utah, USA.
authors: Heather J
authors: HJ
authors: Corn
authors: Department of Internal Medicine, Division of Endocrinology, University of Utah, Salt Lake City, Utah, USA.
authors: Debra L
authors: DL
authors: Simmons
authors: Department of Pathology, University of Utah, Salt Lake City, Utah, USA.
authors: Cheryl Ann
authors: CA
authors: Palmer
authors: Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
authors: William T
authors: WT
authors: Couldwell
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077465:Cabergoline; D003937:Diagnosis, Differential; D019008:Drug Resistance, Neoplasm; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D015175:Prolactinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D000069283:Rituximab / Q000627:therapeutic use; D012658:Sella Turcica / Q000000981:diagnostic imaging*
chemical_list: D000970:Antineoplastic Agents; D004873:Ergolines; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069283:Rituximab; D000077465:Cabergoline
keywords: Antineutrophil cytoplasmic antibodies; Diabetes insipidus; Hyperprolactinemia; Myeloperoxidase antibodies; Perinuclear antineutrophil cytoplasmic antibodies; Wegener granulomatosis