Non-specific granulomas of the pituitary: report of six cases treated surgically

Granulomatous lesions of the pituitary gland are very rare. In our department, six patients with these lesions have been operated on since 1988. The records of these patients were analysed and are reported in the following. Three of the patients were admitted because of severe and rapid development of visual disturbances caused by a suprasellar extending lesion. Endocrinological examination most often found posterior lobe insufficiency, was followed by anterior lobe dysfunction. CT and MRI demonstrated a cystic lesion with semiliquid content, where mild contrast enhancement of the walls of the tumor was observed in all cases. Surgery was performed using the transphenoidal approach. Rapid relief of visual impairment was observed in the three patients with chiasmal compression. In one patient, recurrent chiasm syndrome due to lesion regrowth required additional surgery with transcranial resection of the capsule. Unfortunately, visual impairment persisted postoperatively in one eye. Endocrinological follow-up demonstrated unchanged or even worsened pituitary functions in all cases. Our study revealed no consistent predictive preoperative finding. Therefore, we consider an indication for decompression surgery to be given in all patients with chiasmal syndrome and for diagnostic surgery for all patients with intrasellar lesions.