Presentation
Diabetes insipidus.
Patient Data
Age: 30 years
Gender: Female
From the case:
Lymphocytic hypophysitis
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- absent high T1 signal of the posterior pituitary gland
- thickened intensely enhancing infundibulum with loss of its inferior tapering.
Case Discussion
Her laboratory work-up revealed hypokalemia. Her hormonal profile revealed reduced ADH. The patient didn't suffer any systemic disease.
Diagnosis, in this case, is presumptive depending on the clinical, laboratory, and radiological features of the disease.
Radiological features which could differentiate lymphocytic hypophysitis from pituitary adenoma:
- absent posterior pituitary high signal on non-contrast T1 WI
- thickened enhancing pituitary stalk
- bulky pituitary gland showing homogenous enhancement with no focal lesions
- dural tail sign
- parasellar dark signal encasing the pituitary
Differential diagnosis
- pituitary adenoma
- Secondary types of hypophysitis such as granulomatous hypophysitis caused by sarcoidosis, tuberculosis, Wegner, Langerhans cell histocytosis, IgG4 related granulomatosis
- lymphoma
- pituitary metastasis
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