HYPOPHYSITIS IN SURGICAL AND AUTOPTICAL SPECIMENS

We present the clinical and histological findings of Il cases of infla mmatory anterior pituitary lesions, 8 of which were obtained during su rgery and 3 of which were obtained from autopsies. Additionally, we ex tended the conventional classification of pituitary inflammatory disea se by the new entity ''secondary hypophysitis''. Of the surgically obt ained specimens 5 consisted of inflammatory extension into the pituita ry gland out of the surrounding tissue. In all of these patients the i nflammation originated from an additional tumor in the sellar region ( 4 craniopharyngiomas, 1 prolactinoma). These will be referred to as '' secondary hypophysitis''. an entity which has not yet been mentioned i n the literature. Of the remaining 6 cases, 2 were granulomatous hypop hysitis, 2 pituitary abscesses, 1 lymphocytic hypophysitis, and 1 show ed extensive scarring of the anterior pituitary lobe due to preceeding lymphocytic hypophysitis. At histological examination the basic struc ture of the anterior pituitary was maintained in all cases. Relative c ounts of hormone-producing cells were normal. In secondary hypophysiti s, the affected area was composed of fibrous tissue and granulation ti ssue. B and T lymphocytes were present in equal amounts. Granulomas we re not found. Inflammatory infiltrates, granulation tissue and fibrose s were seen in different proportions. Based on our results and three o ther cases reported in the literature so far, we think that the presen tly used classification of pituitary inflammatory diseases lacks an en tity which describes a non-abscess-forming inflammation of the pituita ry gland originating from an associated pathological process. Therefor e, we introduced the term secondary hypophysitis to describe this four th entity of pituitary inflammatory disease.