Idiopathic giant-cell granulomatous hypophysitis mimicking acute meningitis

A 32-year-old woman presented with severe headache, photophobia, fever, nau sea, vomiting, and worsening vision. She had also noted several months of a menorrhea. She was febrile to 38.9 degrees C. Laboratory evaluation reveale d a markedly elevated erythrocyte sedimentation rate. Lumbar puncture revea led a cerebrospinal fluid lymphocytic pleocytosis and an elevated protein l evel. Endocrine studies revealed evidence of panhypopituitarism without dia betes insipidus. A magnetic resonance imaging study showed a 2-cm pituitary mass with optic chiasmal compression. The patient had a trans-sphenoidal r esection of the mass. Pathology revealed multinucleated giant cells in necr otic debris, but no evidence of pituitary tumor. Studies looking for eviden ce of systemic granulomatous disease were negative. The patient was conside red to have idiopathic giant-cell granulomatous hypophysitis. After surgery , the patient's vision improved and hormone replacement therapy was initiat ed. This case illustrates that idiopathic giant-cell granulomatous hypophys itis should be considered in the differential diagnosis of a patient presen ting with a pituitary mass, hypopituitarism, and meningitis-like symptoms.