Granulomatous hypophysitis: a case of severe headache.
Idiopathic granulomatous hypophysitis (GH) is an uncommon inflammatory disease of the pituitary with impairment of pituitary gland function due to infiltration by lymphocytes, plasma cells and macrophages. We report the case of a 39-year-old woman who presented with worsening of headaches for 1 month and blurring of vision over 5 days. An MRI revealed a homogeneous supra-sellar mass evoking a pituitary tumour with bulky pituitary stalk extending into the left and right cavernous sinuses. Hormonal investigations showed anterior pituitary hormone deficiencies; meanwhile histopathological examination revealed an aspect of hypophysitis. Clinical and radiological remission occurred immediately postglucocorticoid therapy with the addition of a steroid-sparing agent later in view of recurrence of symptoms on glucocorticoid dose reduction. GH has important diagnostic and therapeutic implications, as clinical and radiological features ameliorate via medical treatment. With further understanding and recognition of the disease, we hope to highlight a case of GH, in which signs and symptoms improved after initiation of corticosteroids.
Endocrine Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
Sharifah Faradila
SF
Wan Muhamad Hatta
Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Sungai Buloh, Malaysia.
M Farhan
MF
Hamdan
Department of Anatomy & Pathology, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
Siti Aishah
SA
Md Ali
Endocrine Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
Rohana
R
Abdul Ghani
D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma / Q000175:diagnosis / Q000209:etiology; D006261:Headache / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D000072659:Hypophysitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D007018:Hypopituitarism / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D010902:Pituitary Gland / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000209:etiology; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology
D005938:Glucocorticoids