Hypothalamic-pituitary sarcoidosis. A case report

A 42-year-old woman suffered from sarcoidosis and hypothalamic-pituitary involvement. When she presented initially, an abnormal chest radiograph and abnormal features on histological examination of the lymph nodes, which showed caseating granulomas, suggested a diagnosis of tuberculosis. Failure to respond to antituberculosis therapy and the progressive development of symptoms of both posterior and anterior pituitary deficiency prompted a review of the initial diagnosis. Subsequent dynamic tests of hypothalamic and pituitary function indicated lesions at both the hypothalamic and pituitary levels. Further tests, including the Kveim reaction, favoured a diagnosis of sarcoidosis. This case illustrates the uncommon association of caseating granulomas with sarcoidosis and documents hypopituitarism due to combined hypothalamic and pituitary disease caused by sarcoid infiltration.