P-52 Our objective was to present a case with secondary hypophysitis

Abstract

Abstract Clinical Case A 36-year-old male patient was admitted to an external center with weakness, sexual dysfunction, polydipsia and polyuria. The Laboratory analysis showed partial hypopituitarism (Table 1). The sella MR imaging was performed to determine the etiology. It was showed that the thickness of the pituitary gland was thinner than normal (3 mm, Partially Empty Sella). The pituitary stalk was also significantly enlarged, measuring up to 7.5 mm, and there was an increase in contrast enhancement, as shown in Figure 1. The patient was subsequently started on Prednisolone, L-thyroxine, testosterone propionate, and Desmopressin acetate to treat panhypopituitarism. The ACE level was within the normal range, and tests including quantiferon, vasculitis markers (c-ANCA, P-ANCA, ANA), AFP, Beta hCG, LDH, and beta2 microglobulin all yielded negative results. Given these findings and considering primary hypophysitis, a pulse steroid therapy of 1 gram was administered over a span of 2 days (Figure 1). In the control pituitary MRI 3 months after the treatment: Heterogeneous contrast-enhancing thickening of approximately 16×10mm in the pituitary stalk and a lesion of approximately 22×10mm in the diameter of the epiphysis with heterogeneous contrast enhancement were observed (Figure 2). During this period, the patient was considered to have hypophysitis again, and 1 gr of pulse steroid treatment was administered for 2 days. (Figure 2) Six months after the start of the treatment, the patient was admitted due to sudden onset of double vision and headache. In the pituitary MRI, he was referred to our center upon detection of a 22×13×10 mm contrast-enhancing bilobular lesion that slightly compresses the optic chiasm, and also a 15×10 mm lobulated lesion in the pineal gland (Figure 3). An emergency operation was planned for the lesion, who was compressing the optic chiasm and whose progressing mass size was, for diagnostic and therapeutic purposes. The patient underwent surgery. Preoperative b hCG was negative, and AFP was 2.6 (<13). The histopathological examination revelaed germinoma. Conclusion Hypophysitis is a rare inflammatory disease that affects the pituitary gland and infundibulum as a result of autoimmune, infiltrative, infectious, neoplastic, drug-induced or sometimes unknown pathogenic processes. Some authors recommend a biopsy if the pituitary stalk size is >6.5 mm or if new lesions develop on the stalk. Germinomas, one of the causes of secondary hypophysitis, usually present with a hypothalamic/pineal mass and isolated stalk thickening and has been reported in only a few cases. Serologically, beta human chorionic gonadotropin (β-hCG) and alpha-fetoprotein (85-90%) may be normal in brain germinomas. Therefore, normal negative results of AFP and B-hCG do not exclude germinoma. Table 1