Diffuse Basisphenoid Enhancement: Possible Differentiating Feature for Granulomatous Hypophysitis

Area of Science:

• Radiology
• Endocrinology
• Pathology

Background:

• Granulomatous hypophysitis (GH) is a rare inflammatory pituitary condition that mimics pituitary adenoma (PA) on imaging.
• Accurate differentiation is crucial for appropriate treatment and avoiding unnecessary surgical resection.

Approach:

• This study retrospectively reviewed MRI scans of 3 confirmed GH cases and 100 confirmed PA cases.
• The focus was on identifying diffuse enhancing infrasellar basisphenoid bone marrow as a distinguishing feature.
• Additional imaging findings, clinical history, and pathology were analyzed for comparison.

Key Points:

• All 3 GH cases exhibited diffuse enhancing infrasellar basisphenoid bone marrow.
• None of the 100 PA cases showed this specific imaging finding.
• Patients with GH in this series were all women.

Conclusions:

• Diffuse enhancement of the infrasellar basisphenoid bone marrow is a potential imaging biomarker for differentiating GH from PA.
• This finding can aid in preoperative diagnosis, guiding treatment and potentially preventing misdiagnosis-related surgical intervention.