Simmonds' disease following chronic sclerosing hypophysitis

A case of Simmonds' disease following chronic sclerosing hypophysitis is described in a moderately confused, 54-years-old woman in an extremely advanced cachexia. The patient died four days later in cardio-respiratory failure. The anterior lobe of the hypophysis showed dense, interlacing bands of fibrosis delineating small areas of atrophic pituitary cells. More than four-fifths of the anterior hypophyseal lobe was replaced by fibrosis or dense scarring. A scarce lymphocytic infiltrate between the fibrous bands was noted. The liver showed advanced fatty changes. An interesting finding was the presence of a chronic lymphocytic infiltrate in the adrenals. The association of chronic adrenalitis and sclerosing hypophysitis could be interpreted as an autoimmune endocrinopathy.