A case of idiopathic granulomatous hypophysitis

Area of Science:

• Endocrinology
• Neurology
• Pathology

Background:

• Granulomatous hypophysitis is a rare inflammatory condition affecting the pituitary gland, often presenting with mass effect and hormonal dysfunction.
• Pituitary enlargement is a common feature, but rapid progression can be unusual.

Observation:

• A 31-year-old woman presented with severe headache and bitemporal hemianopsia, indicating optic chiasm compression.
• Initial magnetic resonance imaging (MRI) 4 months prior was normal, but subsequent MRI revealed an 18 × 10-mm sellar mass with suprasellar extension.
• Hormonal evaluation showed hypopituitarism and mild hyperprolactinemia.

Findings:

• Biopsy confirmed granulomatous inflammation with multinucleated giant cells, consistent with granulomatous hypophysitis.
• The rapid development of a pituitary mass and associated symptoms was a key diagnostic challenge.

Implications:

• This case underscores the importance of considering granulomatous hypophysitis in the differential diagnosis of rapidly progressing pituitary masses, even with a prior normal MRI.
• Early diagnosis and appropriate management are crucial for preserving pituitary function and visual acuity.
• Further research into the etiology and optimal treatment strategies for this rare condition is warranted.