Abstract
Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occure in 0.5% of the autoptical specimens and in 2.2% of the surgical cases. Women are significantly more often affected than men and are often younger when first diagnosed. In general, primary and secondary inflammation can be distinguished, with secondary types occurring more frequently (75.1%) than idiopathic inflammatory lesions (15.4%). In primary inflammation, the lymphocytic type is more common (88.5%) than the granulomatous type of hypophysitis (11.5%). The most common causes of secondary inflammation are Rathke’s cleft cysts (48.6%), followed by tumors (17.4%) such as the craniopharyngioma (9.1%), adenoma (5.5%) or germinoma (2.0%). More causes are tumor-like lesions (7.1%) such as xanthogranuloma (3.5%) or Langerhans histiocytosis (3.5%), abscesses (5.5%), generalized infections (5.1%), spreaded inflammations (4.7%) and previous surgeries (4.0%). In 1.6% of all specimens the reason for the inflammation remains unclear. The described classification of hypophysitis is important for specific treatment planning after surgery.
Highlights
Inflammatory findings in the pituitary gland represent a rare differential diagnosis to neoplastic lesions of the sellar region
Primary idiopathic hypophysitis is to be differentiated from secondary types such as inflammatory lesions due to Rathke cleft cysts, craniopharyngeomas or germinomas or involvement of the pituitary in generalized inflammation [3]
The differentiation of inflammatory and tumor-like lesions in the sellar region is very important for the patients
Summary
Inflammatory findings in the pituitary gland represent a rare differential diagnosis to neoplastic lesions of the sellar region. Radiological imaging (Fig. 1) and sometimes even histological findings are often non-specific, a precise diagnosis can be difficult and only be done by comparisons of radiology, pathology and clinical data [1]. Primary idiopathic hypophysitis is to be differentiated from secondary types such as inflammatory lesions due to Rathke cleft cysts, craniopharyngeomas or germinomas or involvement of the pituitary in generalized inflammation (e.g. sarcoidosis, IgG4-related disease) [3]. An autoimmune genesis is assumed in primary hypophysitis, but so far no antipituitary antibodies have been determined whose specificity and sensitivity are high enough to allow an accurate diagnosis [4]. An inflammatory type was described that develops from autoimmunity against the transcription factor PIT-1 [6]
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