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.
Lymphocytic hypophysitis is seen most frequently in women (strong female predilection with a F:M of ~ 9:1), and often in the postpartum period or the third trimester of pregnancy.
Clinical presentation is varied depends on the part of the pituitary affected and 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)
- diabetes insipidus
- both anterior and posterior pituitary: lymphocytic infudibular panhypophysitis (LIPH)
- auto-immune conditions such as
- ipilimumab: monoclonal antibody drug
It is characterised by infiltration of the pituitary stalk with lymphocytes, as the name would suggest.
Coronal CT and multiplanar reconstructions can 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, as is the case with other pituitary lesions, is the best modality for assessing this condition which appears as a pituitary region mass.
- affected area 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
- 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.
The differential diagnosis is primarily that of other pituitary region masses. Considerations include:
- macroadenomas are expected to enlarge the sella turcica
- craniopharyngioma (papillary type)
- suprasellar meningioma
- dural based aspect
- usually follows the cerebral cortex intensity
- pituitary metastasis
- granulomatous hypophysitis (idiopathic of secondary to systemic illness e.g. sarcoidosis, syphilis, and tuberculosis)
- 1. Loevner LA. Brain imaging, case review. Mosby. (2008) ISBN:032303179X. Read it at Google Books - Find it at Amazon
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- 3. Nakata Y, Sato N, Masumoto T et-al. Parasellar T2 Dark Sign on MR Imaging in Patients with Lymphocytic Hypophysitis. 2010;doi:10.3174/ajnr.A2201 - Pubmed citation
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- 6. Levine SN, Benzel EC, Fowler MR et-al. Lymphocytic adenohypophysitis: clinical, radiological, and magnetic resonance imaging characterization. Neurosurgery. 1988;22 (5): 937-41. - Pubmed citation
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- 8. Pisaneschi M, Kapoor G. Imaging the sella and parasellar region. Neuroimaging Clin. N. Am. 2005;15 (1): 203-19. doi:10.1016/j.nic.2005.02.007 - Pubmed citation