title: [A Case of Lymphocytic Adenohypophysitis Presenting Visual Disturbance in the Third Trimester of Pregnancy].
abstract: Lymphocytic hypophysitis(LH)has first been described as an autoimmune endocrinopathy by Goudie in 1962. In particular, lymphocytic adenohypophysitis(LAH)is usually associated with pregnancy and hypopituitarism due to insufficient endocrine of ACTH. However, several cases of LAH in pregnant patients showing only visual disturbances have recently been documented. We treated a patient with LAH presenting only the chiasma syndrome in the third trimester without hypopituitarism. A 27-year-old woman unexpectedly experienced visual disturbance starting in the 28th week of pregnancy. Her symptoms progressed rapidly. MRI revealed a pituitary mass lesion compressing the optic chiasma. In addition, ophthalmological examination revealed bitemporal hemianopsia. The patient underwent endoscopic transsphenoidal surgery(eTSS)during the 30th week of pregnancy. LH was diagnosed histologically during surgery. We performed decompression of optic chiasma. After surgery, the patient's visual field markedly widened and the pituitary mass regressed along with replacement of corticosteroids. In the 37th week of pregnancy, she delivered a healthy baby. We speculate that the reason for the absence of hypopituitarism during pregnancy in patients with LH, especially in the third trimester, might be that the placental endocrine system masks pituitary endocrinopathy. In summary, we report a case of LAH that did not present with hypopituitarism, and eTSS could be performed safely during pregnancy.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Yamagata University.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yaoita
authors.forename: Miiko
authors.initials: M
authors.lastname: Ito
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Matsuda
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kokubo
authors.forename: Shinya
authors.initials: S
authors.lastname: Sato
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sonoda
mesh_terms: D000328:Adult; D000069281:Autoimmune Hypophysitis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010900:Pituitary Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011263:Pregnancy Trimester, Third; D016896:Treatment Outcome