title: Trigemino-autonomic headache and Horner syndrome as a first sign of granulomatous hypophysitis.
abstract: OBJECTIVE
  To report a rare case of incipient granulomatous hypophysitis presenting by atypical trigemino-autonomic cephalalgia (TAC) and Horner syndrome.
  
  
  METHODS
  The patient was investigated with repeated brain MRI, CSF examination, thoracic CT, Doppler and duplex ultrasound of the cerebral arteries, and extensive serologic screening for endocrine and autoimmune markers. Written informed consent was obtained from the patient for access to clinical files for research purposes and for publication.
  
  
  RESULTS
  We present a middle-aged woman with a history of an autoimmune pancreatitis type 2 who had therapy-refractory TAC with Horner syndrome. Initial cerebral MRI showed only indistinct and unspecific signs of a pathologic process. A biopsy revealed a granulomatous hypophysitis. The symptoms disappeared after transsphenoidal subtotal resection of the pituitary mass and anti-inflammatory therapy.
  
  
  CONCLUSIONS
  This case elucidates that inflammatory pituitary diseases must be taken into account in case of atypical and refractory TAC, especially in patients with a history of autoimmune diseases. To our knowledge, the association between TAC accompanied by Horner syndrome and hypophysitis has not yet been described before.
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Jeremias
authors.initials: J
authors.lastname: Motte
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Anna Lena
authors.initials: AL
authors.lastname: Fisse
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Börnke
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schroeder
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Pitarokoili
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Müller
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lukas
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: van de Nes
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Buslei
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.affiliation: Department of Neurology (J.M., A.L.F., C.B., C.S., K.P., R.G., I.A.), Department of Radiology (C.L.), and Institute of Pathology (J.v.d.N.), Ruhr University Bochum; Department of Neurosurgery (I.K.-A., O.M.), and Institute of Neuropathology (J.v.d.N.), University of Duisburg-Essen; and Department of Neuropathology (R.B.), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
authors.forename: Ilya
authors.initials: I
authors.lastname: Ayzenberg