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Granulomatous hypophysitis: two case reports and literature review
Jian Shi1, Jian-Min Zhang, Qun Wu
1Department of Neurosurgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
Journal of Zhejiang University. Science. B
|July 9, 2009
Summary
Granulomatous hypophysitis (GRH) is a rare pituitary gland inflammation often misdiagnosed as pituitary adenoma. Early steroid treatment and surgery can effectively resolve symptoms and shrink masses.
Area of Science:
- Endocrinology
- Neurology
- Pathology
Background:
- Granulomatous hypophysitis (GRH) is an exceptionally rare condition characterized by chronic inflammation of the pituitary gland.
- It often presents with symptoms mimicking pituitary adenoma, leading to diagnostic challenges.
Observation:
- Two female patients, aged 66 and 57, initially diagnosed with pituitary adenoma based on imaging (CT and MRI).
- Symptoms included headache, decreased visual acuity, and ptosis, with one patient showing elevated prolactin levels.
Findings:
- Postoperative histopathology confirmed Granulomatous Hypophysitis in both patients after transsphenoidal microsurgery.
- Treatment with steroids resulted in symptom resolution and significant reduction in sellar mass size on follow-up MRI.
Implications:
- GRH is a rare sellar entity frequently misdiagnosed as pituitary adenoma, highlighting the need for careful differential diagnosis.
- Trans-sphenoidal surgery offers therapeutic benefits for decompression and diagnosis, while hormonal therapy (steroids) is crucial for both diagnosis and treatment.
- Conservative steroid treatment preoperatively is recommended in cases without acute nerve damage.
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