Recurrent lymphocytic hypophysitis: case report.

Abstract

Lymphocytic hypophysitis is being recognized with increasing frequency, but the long-term course is not well known. Recurrence of lymphocytic hypophysitis after a long interval has never been reported. A 53-year-old woman presented with central diabetes insipidus. Magnetic resonance imaging (MRI) revealed an intrasellar lesion. Transsphenoidal biopsy yielded a diagnosis of lymphocytic hypophysitis. Regression of the lesion was confirmed by follow-up MRI. The patient lived normally, with gradual improvement of diabetes insipidus, until she suddenly became aware of a visual defect, which developed into bitemporal hemianopsia 2 years after the biopsy. MRI revealed a larger sellar lesion extending to the hypothalamus. However, the adenohypophysial function remained normal and the mild diabetes insipidus continued unchanged. Prompt corticosteroid treatment was remarkably effective. The visual defect disappeared during steroid therapy, and a significant reduction of the lesion was revealed by MRI. It is suggested that long-term follow-up with endocrinological and radiological studies may be necessary in cases of lymphocytic hypophysitis. Recurrent cases should be promptly treated with steroids when a definitive histological diagnosis had been confirmed.