Diagnosis and management of tumor-like hypophysitis: A retrospective case series

Guo,Songxue; Wang,Chaohui; Zhang,Jianmin; Tian,Yong; Wu,Qun

doi:10.3892/ol.2015.4046

Diagnosis and management of tumor-like hypophysitis: A retrospective case series

Authors:
- Songxue Guo
- Chaohui Wang
- Jianmin Zhang
- Yong Tian
- Qun Wu
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Affiliations: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China, Department of Neurosurgery, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China, Department of Neurosurgery, Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310005, P.R. China
Published online on: December 22, 2015 https://doi.org/10.3892/ol.2015.4046
Pages: 1315-1320
Copyright: © Guo et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Tumor-like hypophysitis is an uncommon sellar condition that presents as inflammatory lesions on the structures of the pituitary gland. The diagnosis and management of hypophysitis poses a significant challenge, as its clinical manifestation and appearance in imaging studies are difficult to distinguish from that of pituitary tumors. The present retrospective study summarizes two rare cases of primary granulomatous hypophysitis, two cases of lymphocytic hypophysitis, and three cases in which a pathological diagnosis was not determined due to the use of hormone replacement therapy only. The mean age of the patients studied was 45.71±22.16 years, and the patients comprised two males and five females. The clinical signs of hypophysitis included headache, fever, gradual decrease in visual acuity, nausea and vomiting. Enhanced magnetic resonance imaging revealed sellar and pituitary stalk lesions, with iso- or hypodense signals on T1‑weighted images. Transsphenoidal surgery was performed in three cases. It was challenging to diagnose hypophysitis due to the lack of any significant specific clinical signs. A transsphenoidal biopsy with fast‑frozen pathology is able to diagnose hypophysitis. Glucocorticoid therapy may be a potential treatment for hypophysitis, as complete removal of pituitary masses may disable pituitary function.

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