Pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroid alone: first case report

Area of Science:

• Endocrinology
• Neuroimmunology
• Oncology

Background:

• Lymphocytic hypophysitis is a rare inflammatory condition of the pituitary gland, often presenting as a pituitary mass.
• Pseudotumoral presentation can mimic pituitary adenomas, leading to diagnostic challenges.

Observation:

• A 27-year-old woman presented with symptoms suggestive of a prolactinoma, including headache, amenorrhea, and galactorrhea, with a pituitary mass on MRI.
• Despite initial treatment with bromocriptine, the patient developed panhypopituitarism and acute adrenal insufficiency, prompting further investigation.
• Human leukocyte antigen typing revealed DR3/DR4, and despite negative autoantibodies, autoimmune hypophysitis was suspected.

Findings:

• Corticosteroid therapy (prednisone) resulted in significant recovery of pituitary hormone function and a two-thirds reduction in pituitary mass.
• The patient experienced a relapse after completing corticosteroid treatment, necessitating further steroid therapy and a biopsy.
• Biopsy confirmed autoimmune hypophysitis, highlighting the inflammatory and autoimmune nature of the condition.

Implications:

• Corticosteroids represent a viable non-surgical treatment option for pseudotumoral lymphocytic hypophysitis, particularly when surgery is refused or contraindicated.
• Early diagnosis and appropriate management of autoimmune hypophysitis are crucial to prevent irreversible pituitary damage.
• This case underscores the importance of considering autoimmune etiologies in pituitary masses that do not respond to standard treatments.