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YOUNG FEMALE POSTPARTUM WITH CEPHALGIA

INFUNDIBULAR MASSDIFFERENTIAL DIAGNOSIS

ADULT: HYPOPHYSITIS

SARCOIDOSIS

METASTASIS

LYMPHOMA

PITUICYTOMA

CHILDREN: HISTIOCYTOSIS

GERMINOMA

LYMPHOMA

LEUKEMIA

LYMPHOCYTIC HYPOPHYSITIS

SYNONYMS: ADENOHYPOPHYSITIS, PRIMARY HYPOPHYSITIS, STALKITIS

DEFINITION: IDIOPATHIC INFLAMMATION OF THE ANTERIOR PITUITARY GLAND

IMAGING FEATURES

THICKENED NONTAPERED STALK, +/- PITUITARY MASS OR ROUNDED GLAND

SUPRASELLAR +/- INTRASELLAR

USUALLY LESS THAN 1 CM BUT CAN BE AS LARGE AS 3 CMS

IMAGING

MRI

T1

THICK STALK >2MM WITH LOSS OF NORMAL

TOP TO BOTTOM TAPERING

+/- ENLARGED PITUITARY GLAND

75% SHOW LOSS OF POSTERIOR PITUITARY BRIGHT SPOT

T1+C

UNIFORM INTENSE ENHANCEMENT

ADJACENT DURAL ENHANCEMENT MAY BE PRESENT

SPHENOID MUSCOSAL THICKENING MAY BE PRESENT

PATHOLOGY

RARE INFLAMMATORY DISORDER OF UNKNOWN EITIOLOGY

ACUTE- DENSE INFILTRATION WITH B/T LYMPHOCYTES, PLASMA CELLS, AND OCCASIONAL EOSINOPHILS

NO GRANULOMAS, GIANT CELLS, ORGANISMS, OR NEOPLASTIC CHARACTER

CHRONIC- FIBROSIS

CLINICAL

PRESENTATION: HEADACHE, VISUAL IMPAIRMENT

PROFILE: PERIPARTUM FEMALE WITH HEADACHE, MULTIPLE ENDOCRINE DEFICIENCIES

M:F 1:8.5

AGE: FEMALE 35 y

PROGNOSIS

UNRECOGNIZE OR UNTREATED CAN RESULT IN DEATH FROM PANHYPOPITUITARISM

TREATMENT- BIOPSY PLUS ENDOCRINE REPLACEMENT THERAPY, CORTICOSTEROIDS