gms | German Medical Science

Objective: The lymphocytic hypophysitis is a rare autoimmune disease occuring in women during late pregnancy or postpartal presenting with hypopituitarism. We present radiologic, clinical and histopathological details of three patients with confirmed lymphocytic hypophysitis along with a review of the current literature.

Method: three young female patients (age 20, 37 and 46 years) were treated surgically due to a sellar mass lesion in 2012. Clinical data, radiological data, treatment details, histopathological details and postoperative course were recorded. A Pubmed search was done to identify current literature (2000–2012) using the search term “lymphocytic hypophysitis”.

Results: In contrast to other reported cases two patients presented with no or only minor hypopituitarism and there was association with pregnancy only in one case. Clinical features were massive and progressive headache and visual impairment in one patient. Magnetic resonance imaging suggested a cystic makroadenoma in two cases. Endonasal transsphenoidal surgery was done to confirm hypophysitis, in two cases a cystic lesion was opened to release a plus-like fluid thus decompressing the sella. Histopathology confirmed lymphocytic hypophysitis in all cases.

Conclusions: Lymphocytic hypophysitis can offer clinical and radiological features distinguishing it from pituitary adenoma however a histological confirmation of the diagnosis is mandatory. Surgical decompression with preservation of pituitary gland and stalk offers a valuable treatment option in case of cystic, space-occupying intrasellar lesion.