LYMPHOCYTIC HYPOPHYSITIS - OCCURRENCE IN 2 MEN

TWO MEN UNDERGOING transsphenoidal exploration for pituitary adenoma w ere found to have lymphocytic hypophysitis. Both presented with fronta l headaches, lethargy, and diminished libido. Laboratory investigation s showed markedly depressed serum testosterone, and magnetic resonance imaging demonstrated pituitary enlargement, with optic chiasm involve ment. Intraoperatively, the dura was adherent to the pituitary in each case. The resected glands were effaced by a dense lymphoplasmacytic i nfiltrate and fibrosis, without granulomas. Nonspecific peripheral enh ancement on imaging suggested a diagnosis other than adenoma, but more experience with peripheral enhancement in lymphocytic hypophysitis is needed. The diagnosis was histological and required surgical interven tion. Long-term pituitary replacement therapy is usually required.