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Lymphocytic hypophysitis

Dr Yuranga Weerakkody and Dr Frank Gaillard et al.

Lymphocytic hypophysitis (LH) is an uncommon non-neoplastic inflammatory condition that affects the pituitary gland. It is closely related to other inflammatory conditions in the region, namely orbital pseudotumour and Tolosa-Hunt syndrome ⁸.

Epidemiology

Lymphocytic hypophysitis is seen most frequently in women (strong female predilection with a M : F of ~ 9 : 1), and often in the post-partum period or in the third trimester of pregnancy.

Clinical presentation

Clinical presentation is varied depends of part of the pituitary affected and on the size of the lesion. Lymphocytic hypophysitis can thus be classified as:

anterior pituitary: lymphocytic adenohypophysitis (LAH)
- most common
- mimics a pituitary adenoma
- endocrine hormone deficits are common
- mass effects on adjacent structures (e.g. optic chiasm)
posterior pituitary: lymphocytic Infundibular neurohypophysitis (LINH)
- rare
- diabetes insipidus
both anterior and posterior pituitary: lymphocytic Infudibular panhypophysitis (LIPH)

Occasionally lymphocytic hypophysitis may be associated with auto-immune conditions such as:

Pathology

It is characterised by infiltration of the pituitary stalk with lymphocytes (as the name would suggest).

Radiographic features

CT

Coronal CT and multiplanar reconstructions are able to visualise the pituitary region reasonably well. Lymphocytic hypophysitis appears as an enhancing soft tissue mass involving the pituitary and extending into the suprasellar region.

MRI

MRI, as is the case with other pituitary lesions, is the best modality for assessing this condition which appears as a pituitary region mass.

T1
- affected region is isointense with slight signal heterogeneity
- normal posterior pituitary bright spot may be absent ⁸
T1 C+ (Gd)
- can variably enhance, usually homogeneously ⁷
- dural enhancement may be present ⁸
- infundibulum may be thickened ⁸
T2
- hypointensity in parasellar region can be present and may be useful in differentiating from a pituitary adenoma ⁴

Treatment and prognosis

Lymphocytic hypophysitis is usually self limiting and spontaneous recovery can occur. Corticosteroids are sometimes given and deficient hormones can be replaced ⁸.