Postpartum Pseudoadenomatous Hypophysitis Simulating a Pituitary Macroadenoma: A Case Report and Literature Review

Abstract

Inflammatory hypothalamo-hypophyseal disorders are uncommon, representing only 1% of hypophyseal lesions. Among these, postpartum lymphocytic hypophysitis emerges as a particularly notable etiology. As a relatively recent entity, its recognition mandates a multidisciplinary approach to ensure preservation of compromised vital prognosis and amelioration of associated neuro-ophthalmologic and/or hypophyseal manifestations. We present a remarkable case of lymphocytic hypophysitis in a 32-year-old woman, unveiled during the postpartum period. Despite employing magnetic resonance imaging (MRI), preoperative diagnosis remained challenging. Surgical intervention became imperative due to progressive visual impairments. Postoperative course demonstrated favorable evolution, characterized by significant enhancement in visual acuity and normalization of cerebral MRI findings during follow-up.

Keywords: endonasal surgery; hypophysitis; pituitary gland.

Fig. 1

Intrasellar and suprasellar mass measuring 2.5 × 2.4 cm, isointense on T1.

Fig. 2

Intrasellar and suprasellar mass measuring 2.5 × 2.4 cm, isointense on T2 with a T2 halo that separate the process from the sellar floor.

Fig. 3

Intrasellar and suprasellar mass enhancing intensely after contrast injection, with a champagne cork appearance, displacing and elevating the optic chiasm upwards, with the pituitary parenchyma pressed against the sellar floor.

Fig. 4

Peroperative image showing at the end of the excision: the optic chiasm, with anterior communicating arteries (ACAs) and the two carotids. The pituitary stalk appeared discontinuous, and the pituitary parenchyma was not visualized in the residual sellar cavity.

Fig. 5

Macroscopic appearance: homogeneous, whitish-yellow lesion with a smooth, multilobulated surface.

Fig. 6

Microscopic appearance: lesion composed of a dense lymphoplasmacytic infiltrate with scattered eosinophils interspersed among large cells exhibiting vesicular nuclei and clear cytoplasm: ( A ) Gx10; ( B ) Gx20; ( C ) Gx40.

Fig. 7

Immunohistochemical analysis: ( A ) showed strong positivity for CD45 in numerous cells of varying sizes, and ( B ) lymphocytic cells stained positive for CD5 and CD3.