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Case Reports
. 2022 Jan 21;10(3):1041-1049.
doi: 10.12998/wjcc.v10.i3.1041.

Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report

Mao-Guang Yang  1 , Han-Qing Cai  1 , Si-Si Wang  1 , Lin Liu  1 , Chun-Mei Wang  2
Affiliations
Case Reports

Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report

Mao-Guang Yang et al. World J Clin Cases. .

Abstract

Background: Lymphocytic hypophysitis (LYH) is an important condition to consider in the differential diagnosis of patients with a pituitary mass. The main clinical manifestations of LYH include headache, symptoms related to sellar compression, hypopituitarism, diabetes insipidus and hyperprolactinemia. Headache, which is a frequent complaint of patients with LYH, is thought to be related to the occupying effect of the pituitary mass and is rapidly resolved with a good outcome after timely and adequate glucocorticoid treatment or surgery.

Case summary: Here, we report a patient with LYH whose initial symptom was headache and whose pituitary function assessment showed the presence of secondary hypoadrenalism, central hypothyroidism and hypogonadotropic hypogonadism. Pituitary magnetic resonance imaging showed symmetrical enlargement of the pituitary gland with suprasellar extension in a dumbbell shape with significant homogeneous enhancement after gadolinium enhancement. The size of the gland was approximately 17.7 mm × 14.3 mm × 13.8 mm. The pituitary stalk was thickened without deviation, and there was an elevation of the optimal crossing. The lesion grew bilaterally toward the cavernous sinuses, and the parasternal dural caudal sign was visible. The patient presented with repeatedly worsening and prolonged headaches three times even though the hypopituitarism had fully resolved after glucocorticoid treatment during this course.

Conclusion: This rare headache regression suggests that patients with chronic headaches should also be alerted to the possibility of LYH.

Keywords: Case report; Glucocorticoid; Headache; Hypopituitarism; Lymphocytic hypophysitis; Magnetic resonance imaging.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Pretreatment coronal magnetic resonance imaging showing pituitary enlargement (arrowhead) and optic chiasm elevation (arrow). A: In the T1 sequence; B: In the T2 sequence; C: Postgadolinium-enhanced coronal magnetic resonance imaging showing an enlarged pituitary gland with significant homogeneous enhancement (arrowhead) and an elevation of the optic chiasm (arrow); D: Posttreatment coronal magnetic resonance imaging showing an almost normal pituitary gland in the T1 sequence; E: Posttreatment coronal magnetic resonance imaging showing an almost normal pituitary gland in the T2 sequence; F: With gadolinium enhancement in the coronal position.
Figure 2
Figure 2
Postgadolinium-enhanced sagittal magnetic resonance imaging. A: Before treatment showing a dural caudal sign (arrow); B: Pretreatment postgadolinium-enhanced coronal magnetic resonance imaging showing no cavernous sinus involvement (arrow); C: Almost disappears after treatment (arrow); D: After treatment postgadolinium-enhanced coronal magnetic resonance imaging showing no cavernous sinus involvement (arrow).
Figure 3
Figure 3
Timeline of the case.
See this image and copyright information in PMC

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