Abstract
Background. Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation. A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion. Lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.
Highlights
Lymphocytic hypophysitis (LyH) is an uncommon intrasellar lesion characterized by lymphocytic infiltration of the adenohypophysis
Autoimmune hypophysitis or lymphocytic hypophysitis – The frequent appearance of lymphocytic infiltration of pituitary gland was seen six months postpartum suggesting its correlation with pregnancy over the last few years increased number of cases occurring without pregnancy have been documented
Based on the anatomy of the pituitary the lymphocytic hypophysitis with the presence of lymphocytic infiltration, lymphocytic hypophysitis can be divided into lymphocytic adenohypophysitis if the anterior pituitary is infiltrated, lymphocytic neurohypophysitis given that the posterior pituitary is involved, lymphocytic infundibulohypophysitis if the pituitary stalk is affected or lymphocytic panhypophysitis if the whole of pituitary if found to have significant findings suggesting the lymphocytic infiltration of the pituitary [6]
Summary
Lymphocytic hypophysitis (LyH) is an uncommon intrasellar lesion characterized by lymphocytic infiltration of the adenohypophysis. Autoimmune hypophysitis or lymphocytic hypophysitis – The frequent appearance of lymphocytic infiltration of pituitary gland was seen six months postpartum suggesting its correlation with pregnancy over the last few years increased number of cases occurring without pregnancy have been documented. Affected patients with this condition usually have the history of other self-immunity disorders in person or a family member [4]. Variable WBC Lymphocyte percent Lymphocyte count Eosinophil percent Eosinophil count Monocyte percent Monocyte count Neutrophil percent Neutrophil count Basophil percent Basophil count Uric acid Sodium (Na) Triglycerides HDL AST ALT ALP DBIL IDBIL TBIL AFP hCG. 0-40 u/l 0-40 u/l 36-110 u/l 0-6 umol/l 5.1-13.7 umol/l 6-20.5 umol/l 0.0-7.02 ng/ml mIU/ml
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