Pituitary sarcoidosis causing secondary amenorrhea. A case report

A 32-year-old woman with hypogonadotropic amenorrhea and sarcoidosis had an enlarged pituitary stalk and gland on computed tomography. Concentrations of luteinizing and growth hormone did not increase after the administration of gonadotropin releasing hormone and insulin-induced hypoglycemia, respectively. The absence of response possibly was the consequence of the patient's estrogen deficiency. The response of thyroid stimulating hormone, prolactin and cortisol was normal after provocative pituitary stimulation. Central nervous system sarcoidosis occurs in 3.5-5.0% of patients with systemic sarcoidosis. Hypothalamic or pituitary sarcoidosis occurs in approximately 0.5% of patients. Diabetes insipidus and hyperprolactinemia are the most frequent manifestations of hypothalamic-pituitary sarcoidosis, occurring in one-half and one-third, respectively, of such patients. Menstrual disturbances, including amenorrhea, are reported infrequently. Computed tomography and provocative pituitary-hypothalamic testing are useful in detecting central nervous system sarcoidosis and in delineating the site of involvement.