Journal of Endocrinological Investigation

, Volume 30, Issue 8, pp 677–683 | Cite as

Hypophysitis superimposed on a non-functioning pituitary adenoma: Diagnostic clinical, endocrine, and radiologic features

  • N. Ballian
  • A. Chrisoulidou
  • P. Nomikos
  • C. Samara
  • G. Kontogeorgos
  • G. A. Kaltsas
Case Report


Pituitary adenomas are common neoplasms requiring medical and/or surgical treatment when associated with hormonal hypersecretion. Treatment of non-functioning pituitary adenomas is necessary when symptoms of mass effect or hormonal deficits occur. However, therapeutic options, including surgical resection and/or radiotherapy, can be associated with significant complications. Hence, it is important to consider disorders that could present in a similar manner to pituitary adenomas, for which surgery is not the indicated therapeutic approach. We describe herein a 38-yr-old woman who presented with a pituitary lesion that was considered to be a non-functioning pituitary adenoma. Due to lack of hormonal deficits and/or compression of adjacent structures, we opted for conservative management and follow-up with consecutive magnetic resonance imaging. Fifteen months after initial diagnosis, considerable enlargement of the lesion was noted, extending mainly superiorly and indenting the optic chiasm. Repeated endocrine investigation revealed partial anterior pituitary insufficiency. The patient underwent trans-sphenoidal resection of the pituitary lesion; histology revealed a null cell pituitary adenoma and lymphocytic hypophysitis (LYH) of the non-neoplastic adenohypophysial gland. Post-operatively, complete anterior and partial posterior pituitary insufficiency developed. This case illustrates the effects of new-onset LYH in a patient with a pre-existing non-functioning pituitary adenoma. Being aware of this rare possibility is important, as enlargement of the pituitary lesion may not be caused by expansion of the preexisting tumor, but by the onset of LYH of the nonneoplastic pituitary tissue.


Hypophysitis pituitary adenoma 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arafah BM, Nasrallah MP. Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr Relat Cancer 2001, 8: 287–305.PubMedCrossRefGoogle Scholar
  2. 2.
    Freda PU, Wardlaw SL. Clinical review 110: Diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab 1999, 84: 3859–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Boelaert K, Gittoes NJ. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 2001, 144: 569–75.PubMedCrossRefGoogle Scholar
  4. 4.
    Heshmati HM, Kujas M, Casanova S, et al. Prevalence of lymphocytic infiltrate in 1400 pituitary adenomas. Endocr J 1998, 45: 357–61.PubMedCrossRefGoogle Scholar
  5. 5.
    Sautner D, Saeger W, Ludecke DK, Jansen V, Puchner MJ. Hypophysitis in surgical and autoptical specimens. Acta Neuropathol (Berl) 1995, 90: 637–44.CrossRefGoogle Scholar
  6. 6.
    Freda PU, Wardlaw SL, Post KD. Unusual causes of sellar/ parasellar masses in a large transsphenoidal surgical series. J Clin Endocrinol Metab 1996, 81: 3455–9.PubMedGoogle Scholar
  7. 7.
    Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR. Autoimmune hypophysitis. Endocr Rev 2005, 26: 599–614.PubMedCrossRefGoogle Scholar
  8. 8.
    Bellastella A, Bizzarro A, Coronella C, Bellastella G, Sinisi AA, De Bellis A. Lymphocytic hypophysitis: a rare or underestimated disease? Eur J Endocrinol 2003, 149: 363–76.PubMedCrossRefGoogle Scholar
  9. 9.
    Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S. Clinical case seminar: Lymphocytic hypophysitis: clinicopathological findings. J Clin Endocrinol Metab 1995, 80: 2302–11.PubMedGoogle Scholar
  10. 10.
    Cheung CC, Ezzat S, Smyth HS, Asa SL. The spectrum and significance of primary hypophysitis. J Clin Endocrinol Metab 2001, 86: 1048–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Beressi N, Beressi JP, Cohen R, Modigliani E. Lymphocytic hypophysitis. A review of 145 cases. Ann Med Interne (Paris) 1999, 150: 327–41.Google Scholar
  12. 12.
    Pressman EK, Zeidman SM, Reddy UM, Epstein JI, Brem H. Differentiating lymphocytic adenohypophysitis from pituitary adenoma in the peripartum patient. J Reprod Med 1995, 40: 251–9.PubMedGoogle Scholar
  13. 13.
    Cosman F, Post KD, Holub DA, Wardlaw SL. Lymphocytic hypophysitis. Report of 3 new cases and review of the literature. Medicine (Baltimore) 1989, 68: 240–56.CrossRefGoogle Scholar
  14. 14.
    Abe T, Matsumoto K, Sano N, Osamura Y. Lymphocytic hypophysitis: case report. Neurosurgery 1995, 36: 1016–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Jane Jr JA, Laws ER. The management of non-functioning pituitary adenomas. Neurol India 2003, 51: 461–5.PubMedGoogle Scholar
  16. 16.
    Leung GK, Lopes MB, Thorner MO, Vance ML, Laws ER. Primary hypophysitis: a single-center experience in 16 cases. J Neurosurg 2004, 101: 262–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH. Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature. Clin Endocrinol (Oxf) 1995, 42: 315–22.CrossRefGoogle Scholar
  18. 18.
    Ahmadi J, Myers GS, Segall HD, Sharma OP, Hinton DR. Lymphocytic adenohypophysitis: contrast-enhanced MR imaging in five cases. Radiology 1995, 195: 30–4.PubMedGoogle Scholar
  19. 19.
    Honegger J, Fahlbusch R, Bornemann A, et al. Lymphocytic and granulomatous hypophysitis: experience with nine cases. Neurosurgery 1997, 40: 713–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Saiwai S, Inoue Y, Ishihara T, et al. Lymphocytic adenohypophysitis: skull radiographs and MRI. Neuroradiology 1998, 10: 114–20.CrossRefGoogle Scholar
  21. 21.
    Chelaïfa K, Bouzaïdi K, Harzallah F, et al. Lymphocytic hypophysitis. J Neuroradiol 2002, 29: 57–60.PubMedGoogle Scholar
  22. 22.
    Nishiyama S, Takano T, Hidaka Y, Takada T, Iwatani Y, Amino N. A case of postpartum hypopituitarism with empty sella: possible relation to postpartum autoimmune hypophysitis. Endocr J 1993, 40: 431–8.PubMedCrossRefGoogle Scholar
  23. 23.
    O’Dwyer DT, Smith AI, Matthew ML, et al. Identification of the 49-kDa autoantigen associated with lymphocytic hypophysitis as alpha-enolase. J Clin Endocrinol Metab 2002, 87: 752–7.PubMedGoogle Scholar
  24. 24.
    De Bellis A, Sinisi AA, Conte M, et al. Antipituitary antibodies against gonadotropin-secreting cells in adult male patients with apparently idiopathic hypogonadotrophic hypogonadism. J Clin Endocrinol Metab 2007, 92: 604–7.PubMedCrossRefGoogle Scholar
  25. 25.
    De Bellis A, Salerno M, Conte M, et al. Antipituitary antibodies recognizing growth hormone (GH)-producing cells in children with idiopathic GH deficiency and in children with idiopathic short stature. J Clin Endocrinol Metab 2006, 91: 2484–9.PubMedCrossRefGoogle Scholar
  26. 26.
    De Bellis A, Bizzarro A, Conte M, et al. Antipituitary antibodies in adults with apparently idiopathic growth hormone deficiency and in adults with autoimmune endocrine diseases. J Clin Endocrinol Metab 2003, 88: 650–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Tanaka S, Tatsumi KI, Takano T, et al. Anti-alpha-enolase antibodies in pituitary disease. Endocr J 2003, 50: 697–702.PubMedCrossRefGoogle Scholar
  28. 28.
    Crock PA. Cytosolic autoantigens in lymphocytic hypophysitis. J Clin Endocrinol Metab 1998, 83: 609–18.PubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2007

Authors and Affiliations

  • N. Ballian
    • 1
  • A. Chrisoulidou
    • 2
  • P. Nomikos
    • 3
  • C. Samara
    • 4
  • G. Kontogeorgos
    • 5
  • G. A. Kaltsas
    • 6
  1. 1.Department of SurgeryUniversity of Wisconsin Hospital and ClinicsMadisonUSA
  2. 2.Department of EndocrinologyTheagenion HospitalThessaloniki
  3. 3.Department of NeurosurgeryYgia HospitalItaly
  4. 4.Department of RadiologyItaly
  5. 5.Department of HistopathologyG. Gennimatas HospitalGreece
  6. 6.Department of PathophysiologyNational University of AthensAthensGreece

Personalised recommendations