Lymphocytic hypophysitis: Its expanding features

Lymphocytic hypophysitis is classically defined as an inflammatory disorder confined to adenohypophysis However, it has recently been indicated that i nfundibuloneurohypophysitis underlies some subsets of central diabetes insi pidus (DI). Therefore, lymphocytic hypophysitis can be considered a syndrom e including disorders of both the anterior pituitary (lymphocytic adenohypo physitis) and the posterior pituitary (lymphocytic infundibuloneurohypophys itis). We describe a 77-yr-old woman with lymphocytic hypophysitis presenti ng with headache, diplopia, general malaise and appetite loss. Head magneti c resonance imaging (MRI) demonstrated pituitary swelling and dura mater th ickening on the dorsum sella. Endocrinological investigations revealed both anterior and posterior pituitary dysfunction associated with primary hypot hyroidism due to Hashimoto's thyroiditis. Headache and diplopia spontaneous ly disappeared, and anterior pituitary dysfunction, general malaise and app etite loss improved after taking 10 mg hydrocortisone daily, although ACTH hyposecretion persisted. Pituitary swelling was thereafter reduced but the dura mater thickening persisted. We suggest that this case may represent a variant of lymphocytic hypophysitis in which chronic inflammatory process i nvolves both the anterior and the posterior pituitary gland, infundibulum, dura mater on the dorsum sella and cavernous sinus. Regarding expanding fea tures of lymphocytic hypophysitis, it may be considered a syndrome includin g heterogeneous disorders, of which the pathogenesis remains to be elucidat ed. (C) 2001, Editrice Kurtis.