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[Autoimmune hypophysitis or lymphocytic hypophysitis].

Isabel Paiva1, Leonor Gomes, Cristina Ribeiro

  • 1Serviço de Endocrinologia Diabetes e Metabolismo, Hospitais da Universidade de Coimbra.

Acta Medica Portuguesa
|January 6, 2005
PubMed
Summary

Lymphocytic hypophysitis is a rare pituitary inflammation often seen in postpartum women. Early diagnosis and corticosteroid treatment can manage symptoms and neurological effects, though hormone deficiencies may persist.

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Area of Science:

  • Endocrinology
  • Neuroimmunology
  • Pathology

Background:

  • Lymphocytic hypophysitis, first described in 1962, is an inflammatory condition affecting the pituitary gland.
  • It is characterized by pituitary lymphoplasmacytic infiltrate and often presents with hypopituitarism, particularly adrenal insufficiency, in peripartum women or those with autoimmune diseases.

Observation:

  • The case involves a woman in the early postpartum period with depression and Graves disease, presenting with hyperprolactinemia and ACTH deficiency.
  • Magnetic resonance imaging (MRI) did not reveal pituitary changes, despite clinical suspicion of lymphocytic hypophysitis.

Findings:

  • Diagnosis of lymphocytic hypophysitis is histologically confirmed due to the lack of specific serological tests.
  • Endocrine deficiencies resulting from hypophysitis are often permanent.

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  • Corticosteroid therapy is effective in reducing neurological symptoms and pituitary enlargement, potentially avoiding surgery.

    • Implications:

    • This case highlights the importance of considering lymphocytic hypophysitis in postpartum women with endocrine dysfunction, even without clear MRI findings.
    • Prompt treatment with corticosteroids can alleviate neurological symptoms and manage hyperthyroidism and depression.
    • While some hormonal functions may recover spontaneously, long-term hormone replacement therapy, such as glucocorticoids, may be necessary.