CLC number: R742
On-line Access: 2024-08-27
Received: 2023-10-17
Revision Accepted: 2024-05-08
Crosschecked: 2009-06-11
Cited: 12
Clicked: 6767
Jian SHI, Jian-min ZHANG, Qun WU, Gao CHEN, Hong ZHANG, Wen-liang BO. Granulomatous hypophysitis: two case reports and literature review[J]. Journal of Zhejiang University Science B, 2009, 10(7): 552-558.
@article{title="Granulomatous hypophysitis: two case reports and literature review",
author="Jian SHI, Jian-min ZHANG, Qun WU, Gao CHEN, Hong ZHANG, Wen-liang BO",
journal="Journal of Zhejiang University Science B",
volume="10",
number="7",
pages="552-558",
year="2009",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B0820355"
}
%0 Journal Article
%T Granulomatous hypophysitis: two case reports and literature review
%A Jian SHI
%A Jian-min ZHANG
%A Qun WU
%A Gao CHEN
%A Hong ZHANG
%A Wen-liang BO
%J Journal of Zhejiang University SCIENCE B
%V 10
%N 7
%P 552-558
%@ 1673-1581
%D 2009
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B0820355
TY - JOUR
T1 - Granulomatous hypophysitis: two case reports and literature review
A1 - Jian SHI
A1 - Jian-min ZHANG
A1 - Qun WU
A1 - Gao CHEN
A1 - Hong ZHANG
A1 - Wen-liang BO
J0 - Journal of Zhejiang University Science B
VL - 10
IS - 7
SP - 552
EP - 558
%@ 1673-1581
Y1 - 2009
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B0820355
Abstract: granulomatous hypophysitis (GRH) is extremely rare and commonly presents with chronic inflammatory of the enlarged pituitary gland. In our study, 66-year-old and 57-year-old women, both Chinese, were diagnosed with GRH presenting preoperatively definite imageology characters as pituitary adenoma. The 66-year-old woman presented with a year of headache, half a year of gradual decrease of visual acuity, and one month of right ptosis. Serum prolactin level was slightly elevated. Screening computed tomography (CT) scanning revealed typical low density mass found on the enlarged sella, which demonstrated invasive extension from the sella to the right cavernous sinus by contrast enhanced magnetic resonance imaging (MRI). Consequently, the patient was diagnosed with probable invasive pituitary adenoma. The other 57-year-old woman complained a light headache and had been previously treated as nonfunctional pituitary adenoma in other hospital. Finally these two patients underwent transsphenoidal microsurgery and were diagnosed with GRH according to postoperative histopathology. They then were treated with steroid. During the follow-up, the clinical symptoms such as headache, visual damage, and ptosis vanished, and the mass of the sellae dramatically shrank on repeated MR images. Clinically and radiologically, GRH is a rare sellar entity easily to be misdiagnosed as a pituitary adenoma. trans-sphenoidal surgery can decompress the optical nerve or oculomotornerve as a therapeutic strategy, and support biopsy or further pathological diagnosis. However, the hormonal therapy should be emphasized both as diagnostic and therapeutic strategies. Conservative and tentative steroid treatment should be performed in preoperative period without acute nerve damage.
[1] Albini, C.H., MacGillivray, M.H., Fisher, J.E., Voorhess, M.L., Klein, D.M., 1988. Triad of hypopituitarism, granulomatous hypophysitis, and ruptured Rathke’s cleft cyst. Neurosurgery, 22(1):133-136.
[2] Arsava, E.M., Uluc, K., Kansu, T., Dogulu, C.F., Soylemezoglu, F., Selekler, K., 2001. Granulomatous hypophysitis and bilateral optic neuropathy. J. Neuroophthalmol., 21(1):34-36.
[3] Beressi, N., Cohan, R., Beressi, J.P., Dumas, J.L., Legrand, M., Iba-Zizen, M.T., Modigliani, E., 1994. Pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroid alone: first case report. Neurosurgery, 35(3): 505-508.
[4] Bhansali, A., Velayutham, P., Radotra, B.D., Pathak, A., 2004. Idiopathic granulomatous hypophysitis presenting as non-functioning pituitary adenoma: description of six cases and review of literature. Br. J. Neurosurg., 18(5): 489-494.
[5] Bhardwaj, M., Sharma, A., Pal, H.K., 2005. Granulomatous hypophysitis. Neurol. India, 53(3):364-365.
[6] Bhaya, A., 1999. Granulomatous hypophysitis—a rare entity mimicking pituitary adenoma. Indian J. Radiol. Imaging, 9(4):203-204.
[7] Brisman, M.H., Morgello, S., Silvers, A., Klein, I., Post, K.O., 1996. Idiopathic granulomatous hypophysitis. Neurosurg. Focus, 1(1):e8.
[8] Buxton, N., Robertson, I., 2001. Lymphocytic and granulomatous hypophysitis: a single centre experience. Br. J. Neurosurg., 15(3):242-245.
[9] Caturegli, P., Newschaffer, C., Olivi, A., 2005. Autoimmune hypophysitis. Endocrine Reviews, 26(5):599-614.
[10] Cooper, R., Belilos, E., Drexler, S., Efron, A., Ferrara, E., Tollin, S.R., 1999. Idiopathic giant-cell granulomatous hypophysitis mimicking acute meningitis. Am. J. Med. Sci., 318(5):339-342.
[11] de Bruin, W.I., van′t Verlaat, J.W., Graamans, K., de Bruin, T.W.A., 1991. Sellar granulomatous mass in a pregnant woman with active Crohn’s disease. Neth. J. Med., 39(3-4):136-141.
[12] Fernandez, A.J., Fraile, O.I., Medina, P.M., 1990. Granulomatous hypophysitis probably of autoimmune etiology. A case diagnosed post mortem. Med. Clin. (Barc.), 95(3): 100-102.
[13] Goyal, M., Kucharczyk, W., Keystone, E., 2000. Granulomatous hypophysitis due to Wegener’s granulomatosis. AJNR, 21(8):1466-1469.
[14] Gutenberg, A., Buslei, R., Fahlbusch, R., Buchfelder, M., Bruck, W., 2005. Immunopathology of primary hypophysitis: implications for pathogenesis. Am. J. Surg. Pathol., 29(3):329-338.
[15] Hassoun, P., Anayssi, E., Salti, I., 1985. A case of granulomatous hypophysitis with hypopituitarism and minimal pituitary enlargement. J. Neurol. Neurosurg. Psychiatry, 48(9):949-951.
[16] Higuchi, M., Arita, N., Mori, S., Satoh, B., Mori, H., Hayakawa, T., 1993. Pituitary granuloma and chronic inflammation of hypophysis: clinical and immunohistochemical studies. Acta Neurochir. (Wien.), 121(3-4): 152-158.
[17] Honegger, J., Fahlbusch, R., Bornemann, A., Hensen, J., Buchfelder, M., Muller, M., Nomikos, P., 1999. Lymphocytic and granulomatous hypophysitis: experience with nine cases. Neurosurgery, 44(4):713-722.
[18] Illueca, C., Cerda-Nicolas, M., Roldan, P., Tlamantes, F., Ascaso, J., Liombart-Bosch, A., 2002. Idiopathic granulomatous hypophysitis. Morphological and immunohistochemical study of a case. Neurocirugia (Astur.), 13(2): 137-141.
[19] Inoue, T., Kaneko, Y., Mannoji, H., Fukui, M., 1997. Giant cell granulomatous hypophysitis manifesting as an intrasellar mass with unilateral ophthalmoplegia: case report. Neurol. Med. Chir. (Tokyo), 37(10):766-770.
[20] Jastania, R., Nageeti, T., Kovacs, K., Ezzat, S., Asa, S.L., 2004. Granulomatous hypophysitis with psammoma bodies: a diagnostic dilemma. Endocr. Pathol., 15(4):359-363.
[21] Madsen, J.R., Karluk, D., 2000. Case records of the massachusetts general hospital, case 34-2000: a 71-year-old woman with an enlarging pituitary mass. N. Engl. J. Med., 343(19):1399-1406.
[22] Miyamoto, M., Sugawa, H., Mori, T., Hashimoto, N., Imura, H., 1988. A case of hypopituitarism due to granulomatous and lymphocytic adenohypophysitis with minimal pituitary enlargement: a possible variant of lymphocytic adenohypophysitis. Endocrinol. Jpn, 35(7):607-616.
[23] Nagi, S., Megdiche, H., Nouira, K., Bouraoui, S., Mekni, A., Jemli, C., Sebai, R., Zitouna, M., Touibi, S., 2002. Idiopathic granulomatous hypophysitis: clinical appearance and imaging. J. Neuroradiol., 29(1):43-48.
[24] Roncaroli, F., Bacci, A., Frank, G., Calbucci, F., 1998. Granulomatous hypophysitis caused by a ruptured intrasellar Rathke’s cleft cyst: report of a case and review of the literature. Neurosurgery, 43(1):146-149.
[25] Sato, N., Sze, G., Endo, K., 1998. Hypophysitis: endocrinologic and dynamic MR findings. AJNR, 19(3):439-444.
[26] Sautner, D., Saeger, W., Ludecke, D.K., Jansen, V., Puchner, M.J., 1995. Hypophysitis in surgical and autoptical specimens. Acta Neuropathol., 90(6):637-644.
[27] Scanarini, M., d′Avella, D., Rotilio, A., Kitromilis, N., Mingrino, S., 1989. Giant-cell granulomatous hypophysitis: a distinct clinicopathological entity. J. Neurosurg., 71(5): 681-686.
[28] Shimizu, C., Kubo, M., Kijima, H., Ishizu, A., Katoh, T., Koike, T., 1998. Giant cell granulomatous hypophysitis with remarkable uptake on Gallium-67 scintigraphy. Clin. Endocrinol. (Oxf), 49(1):131-134.
[29] Tashiro, T., Sano, T., Xu, B., Wakatsuki, S., Kagawa, N., Nishioka, H., Yamada, S., Kovacs, K., 2002. Spectrum of different types of hypophysitis: a clinicopathologic study of hypophysitis in 31 cases. Endocr. Pathol., 13(3): 183-195.
[30] Taylon, C., Duff, T.A., 1980. Giant cell granuloma involving the pituitary gland: case report. J. Neurosurg., 52(4): 584-587.
[31] Thiryayi, W., Donaldson, M.H., Border, D., Tyagi, A., 2007. An enhancing pituitary lesion in a young woman: a diagnostic dilemma. J. Clin. Neurosci., 14(3):286-288.
[32] Toth, M., Szabo, P., Racz, K., Szende, B., Baloqh, I., Czirjak, S., Slowik, F., Glaz, E., 1996. Granulomatous hypophysitis associated with Takayasu’s disease. Clin. Endocrinol. (Oxf.), 45(4):499-503.
[33] Unlu, E., Puyan, F.O., Biliqi, S., Kemal Hamamcioqlu, M., 2006. Granulomatous hypophysitis: presentation and MRI appearance. J. Clin. Neurosci., 13(10):1062-1066.
[34] Vasile, M., Marsot-Dupuch, K., Kujas, M., Brunereau, L., Bouchard, P., Comoy, J., Tubiana, J.M., 1997. Idiopathic granulomatous hypophysitis: clinical and imaging features. Neuroradiology, 39(1):7-11.
[35] Wilson, J.D., Jacobs, M., Shuer, L., Atlas, S., Horoupian, D.S., 2000. Idiopathic giant-cell granulomatous hypophysitis. Report of a case with autopsy follow-up. Clin. Neuropathol., 19(6):300-304.
[36] Yamagami, K., Yoshioka, K., Sakai, H., Fukumoto, M., Yamakita, T., Hosoi, M., Ishii, T., Sato, T., Tanaka, S., Fujii, S., 2003. Treatment of lymphocytic hypophysitis by high-dose methylprednisolone pulse therapy. Intern. Med., 42(2):168-173.
[37] Yoshioka, M., Yamakawa, N., Saito, H., Yoneda, M., Nakayama, T., Kuroki, M., Tsuchida, T., Sekiya, M., 1992. Granulomatous hypophysitis with meningitis and hypopituitarism. Intern. Med., 31(9):1147-1150.
Open peer comments: Debate/Discuss/Question/Opinion
<1>