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Journal of Zhejiang University SCIENCE B 2009 Vol.10 No.7 P.552-558


Granulomatous hypophysitis: two case reports and literature review

Author(s):  Jian SHI, Jian-min ZHANG, Qun WU, Gao CHEN, Hong ZHANG, Wen-liang BO

Affiliation(s):  Department of Neurosurgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more

Corresponding email(s):   wuqun30639@sina.com

Key Words:  Granulomatous hypophysitis, Steroid treatment, Imageology, Trans-sphenoidal surgery

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.

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publisher="Zhejiang University Press & Springer",

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%T Granulomatous hypophysitis: two case reports and literature review
%A Jian SHI
%A Jian-min ZHANG
%A Qun WU
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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
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PB - Zhejiang University Press & Springer
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DOI - 10.1631/jzus.B0820355

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.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


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