Necrotizing infundibulo-hypophysitis: case-report and literature review

Abstract

Purpose: We describe a rare case of histopathologic-proven necrotizing infundibulo-hypophysitis (NIH).

Clinical history: A 40-year-old female presented with coexistence of central diabetes insipidus and hypopituitarism. Imaging disclosed a thickened infundibulum and a diffusely enlarged pituitary mass with gadolinium rim enhancement pattern. Microsurgical endonasal transsphenoidal resection was performed. The presence of extensive liquefactive necrosis, surrounded by lymphoplasmocytic inflammatory infiltrate, allowed for the diagnosis of NIH. Follow-up cranial imaging 10 months after surgery showed no evidence of reappearance of the lesion. There was no progression to panhypopituitarism.

Conclusion: Surgery and histopathological confirmation are the key diagnostic feature in NIH. The current case is the fifth report of NIH and the first one with an indolent course and without progression to panhypopituitarism so far.

Keywords: Diabetes insipidus; hypophysitis; hypopituitarism; necrotizing.