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Lymphocytic Hypophysitis


KEY FACTS

Terminology

  • Lymphocytic hypophysitis (LH)

  • Synonyms: Adenohypophysitis, primary hypophysitis, stalkitis

  • Idiopathic inflammation of pituitary gland &/or stalk

Imaging

  • Thick stalk (> 2 mm + loss of normal “top to bottom” tapering)

  • ± enlarged pituitary gland

  • 75% show loss of posterior pituitary “bright spot”

  • Enhances intensely, uniformly

  • May have adjacent dural or sphenoid sinus mucosal thickening

Top Differential Diagnoses

  • Macroadenoma

  • Pituitary hyperplasia

  • Adolescent pituitary gland

  • Granulomatous disease

  • Pituitary “dwarf”

  • Ectopic posterior pituitary gland

Clinical Issues

  • Peripartum woman with headache, multiple endocrine deficiencies

  • Middle-aged man with diabetes insipidus (lymphocytic infundibuloneurohypophysitis)

  • Mean in women = 35 years, men = 45 years

  • M:F = 1:8-9

  • Often self-limited

  • Unrecognized, untreated LH can result in death from panhypopituitarism

  • Conservative care (steroids, hormone replacement)

Diagnostic Checklist

  • LH can mimic pituitary adenoma

Sagittal graphic shows lymphocytic hypophysitis. Note thickening of the infundibulum with loss of the normal “top to bottom” tapering as well as infiltration into the anterior lobe of the pituitary gland
.

Coronal T2 MR in a pregnant woman with visual changes and endocrine abnormalities shows a hyperintense sellar/suprasellar mass with superior displacement of the optic chiasm
. Surgery for optic chiasm decompression disclosed lymphocytic hypophysitis. Imaging mimics pituitary macroadenoma.

Sagittal T1 C+ MR shows a prominent pituitary gland
in a 37-year-old man with panhypopituitarism during treatment with ipilimumab for metastatic melanoma. The gland had doubled in size since MR 6 weeks prior. Findings are consistent with drug-induced hypophysitis.

Sagittal T1 C+ MR in a 50-year-old patient with diabetes insipidus shows focal enlargement of the pituitary infundibulum
related to lymphocytic infundibuloneurohypophysitis.

TERMINOLOGY

Abbreviations

  • Lymphocytic hypophysitis (LH)

Synonyms

  • Adenohypophysitis, primary hypophysitis, stalkitis

Definitions

  • Idiopathic inflammation of pituitary gland or stalk

IMAGING

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