Diagnosis and management of granulomatous hypophysitis

Abstract

Objective To investigate the diagnosis and management of granulomatous hypophysitis.Methods Seven patients with granulomatoushypophysitis were retrospectively analyzed with their signs and symptoms,radiological characteristics,diagnosis,and treatments.Results In the seven cases,six cases were misdiagnosed before operations.The clinical signs were headaches,diabetes inspidus,hyperprolactinemia,and hypopituitarism.Pituitary stalk thickening is a prominent image feature and is associated with the tongue-like extension of the sellar lesion into the suprasellar region.Surgery via the transsphenoidal route was performed on six cases and the transfrontal approach was chosen for one patient due to the additional diagnosis of onabscess preoperatively.Most of the patients had remission of clinical symptoms and signs after surgery with steroids and hormones replacement and lesions were reduced or even disappeared on MRI images.Conclusions Surgical intervention should be performed because it is difficult to make correct pathological diagnosis of granulomatous hypophysitis preoperatively and may improve symptoms and signs.Steroids and hormones replacement should be administrated after surgery and patients should be followed-up because of the natural course of the disorder. Key words: Granulomatous hypophysitis ; Diabetes inspidus ; Hyperprolactinemia; Hypopituitarism; Treatment