April - June 2015, Volume 11, Issue 2

Kyriakos G, Villar-Taibo R, Vidal-Casariego A, Ballesteros-Pomar MD, Álvarez-San Martín RM, Cano-Rodríguez I

Granulomatous Hypophysitis: A Diagnostic Challenge before and after Surgery

Acta Endo (Buc) 2015, 11 (2): 228-232
doi: 10.4183/aeb.2015.228

Granulomatous hypophysitis is a very rare inflammatory lesion of the pituitary gland. Its typical clinical presentation is as an expanding sellar mass mimicking an adenoma, making it difficult to confirm the disease without a histopathological examination. Furthermore, determining the underlying etiology is a significant diagnostic challenge for clinicians. Case Report. We report the case of a 42-year-old female who presented with a history of severe headache and a sellar mass on imaging; she was initially diagnosed with an invasive pituitary adenoma but received a final diagnosis of granulomatous hypophysitis. The differential diagnosis was focused on idiopathic granulomatous hypophysitis versus tuberculous hypophysitis. On the one hand, the patient did not present signs of active tuberculosis nor of a systemic disease, and the PCR for mycobacteria on the pituitary tissue was negative; therefore, a diagnosis of idiopathic granulomatous hypophysitis would be appropriate. However, because the patient was proceeding from an endemic zone of tuberculosis and her Mantoux and QuantiFERON tests were positive, tuberculous hypophysitis could not be totally excluded. Conclusions. This case highlights the difficulties of correctly diagnosing granulomatous hypophysitis, even postoperatively, and the need to be aware of this rare entity when evaluating a pituitary enlargement in order to provide the most appropriate treatment.

Keywords: granulomatous hypophysitis, pituitary tuberculosis, sellar mass.

Correspondence: Georgios Kyriakos MD, Complejo Asistencial Universitario de León, Endocrinology and Nutrition, Altos de Nava s/n, León, 24008, Spain, E-mail: giorgos6@yahoo.com