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TheScientificWorldJOURNAL
Volume 10, Pages 126-134
http://dx.doi.org/10.1100/tsw.2010.24
Case Study

Lymphocytic Hypophysitis: Differential Diagnosis and Effects of High-Dose Pulse Steroids, Followed by Azathioprine, on the Pituitary Mass and Endocrine Abnormalities — Report of a Case and Literature Review

1Department of Medicine and Pharmacology, Section of Endocrinology, University of Messina, Italy
2Department of Neurosurgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
3Department of Pathology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
4Translational Research Unit, Department of Oncology, Hospital of Prato, Istituto Toscana Tumori, Florence, Italy

Received 26 September 2009; Revised 8 January 2010; Accepted 11 January 2010

Academic Editor: Lawrence A. Frohman

Copyright © 2010 Lorenzo Curtò et al.

Abstract

We report on a man with a progressively increasing pituitary mass, as demonstrated by MRI. It produced neurological and ophthalmological symptoms, and, ultimately, hypopituitarism. MRI also showed enlargement of the pituitary stalk and a dural tail phenomenon. An increased titer of antipituitary antibodies (1:16) was detected in the serum. Pituitary biopsy showed autoimmune hypophysitis (AH). Neither methylprednisolone pulse therapy nor a subsequent treatment with azathioprine were successful in recovering pituitary function, or in inducing a significant reduction of the pituitary mass after an initial, transient clinical and neuroradiological improvement. Anterior pituitary function evaluation revealed persistent hypopituitarism. AH is a relatively rare condition, particularly in males, but it represents an emerging entity in the diagnostic management of pituitary masses. This case shows that response to appropriate therapy for hypophysitis may not be very favorable and confirms that diagnostic management of nonsecreting pituitary masses can be a challenge. Clinical, imaging, and laboratory findings are useful for suggesting the diagnosis, but pituitary biopsy may be necessary to confirm it.