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2.1
Giant-Cell Granulomatous Hypophysitis

Presentation

Four cases are presented here with radiological, endocrinological, and surgical findings. [ncbi.nlm.nih.gov]

[…] and proteomic analysis, all the way to clinical analysis (histopathology and imaging) and new therapeutic approaches Clear presentation by endocrine researchers of the cellular and molecular mechanisms underlying pituitary hormones and growth factors [books.google.com]

Our patient presented with severe headache and features of panhypopituitarism. [japi.org]

Neurologic

  • Irritability

    With mass effect and dural irritation, headache, and visual impairment have been reported in up to 50–70% of cases. Bitemporal hemianopsia accounts for the majority of visual symptoms, with impaired acuity and diplopia being relatively uncommon. [surgicalneurologyint.com]

Workup

Autoimmune workup did not reveal any abnormality with CRP - 1.2 mg/l (normal < 7 mg/l); antinuclear antibodies (< 1:40), and antineutrophilic cytoplasmic antibodies (< 1:16), anti-TPO Ab - 4 IU/l (< 9), RA factor 4 IU/l (< 20), and anti-TTG Ab- 3.54 IU [ijem.in]

X-Ray

  • Enlarged Sella

    The MR imaging features included a thickened stalk, a diffusely and uniformly enlarged gland, a normal size or minimally enlarged sella, and enhancement of the optic chiasm. Hypophysitis is of two types: lymphocytic and granulomatous. [ajnr.org]

    Magnetic resonance imaging (MRI) scan demonstrated an enlarged sella and a large well-marginated patchily enhancing soft tissue mass within sellar and suprasellar regions. There was no parasellar extension, and no necrosis or hemorrhage. [cancerjournal.net]

    An unusual cause of hyperprolactinemia and enlarged sella turcica. JAMA. 1981. 246: 1811-2 36. Rivera JA. Lymphocytic hypophysitis: Disease spectrum and approach to diagnosis and therapy. Pituitary. 2006. 9: 35-45 37. [surgicalneurologyint.com]

Serum

  • Hyperprolactinemia

    This entity should be considered when evaluating patients with a pituitary mass and evidence of hypopituitarism and hyperprolactinemia. [ncbi.nlm.nih.gov]

    This is especially true for patients with hyperprolactinemia, diabetes insipidus or hypopituitarism. Medical therapy is aimed at treating endocrinopathies and replacing deficient hormones. [ccpd.ucsf.edu]

    Serum levels of LH and follicle-stimulating hormone were normal over time, and mild hyperprolactinemia was present with normal increments over time ( Table 2 ). [kjim.org]

    In this case, there was hyperprolactinemia secondary to stalk compression and, as demonstrated by MRI, the epicenter of the mass is located inside the sella. [path.upmc.edu]

    The hormonal abnormalities have varied from panhypopituitarism to single hormone abnormalities such as hyperprolactinemia, hypothyroidism, or hypoadrenalism. [pituitaryadenomas.com]

Other Pathologies

  • Granulomatous Tissue

    The granulomatous reaction area that can accompany these rare tumors can lead to diagnostic errors unless adequate tissue and serial sections are available. [turkjpath.org]

Treatment

Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]

OBJECTIVE: To describe the clinical features of giant-cell granulomatous hypophysitis and to report on the results of corticosteroid treatment. [ncbi.nlm.nih.gov]

Corticosteroids are considered as primary treatment along with desmopressin if patients have DI to avoid traumatic effects of surgery. Surgical treatment is useful for relieving the elevated pressure effects on optic and occulomotor nerve. [jpgo.org]

Diagnosis and Treatment Accurate diagnosis of De Quervian’s thyroiditis is important because, unlike other conditions that cause symptoms of hyperthyroidism, it resolves spontaneously without the need for a specific treatment. [news-medical.net]

Prognosis

Provides all the information essential for completing a sign-out report: clinical findings, pathologic findings, diagnosis, treatment, and prognosis. [books.google.com]

Treatment and prognosis Based on case series-level evidence, good response is seen to corticosteroids such as prednisolone or hydrocortisone 1,2. [radiopaedia.org]

The effectiveness of radiotherapy is unknown in germinomas with granulomatous reaction but it has been reported to lead to a favorable prognosis 5. [turkjpath.org]

Radical surgery is the treatment of choice and carries an excellent prognosis with no recurrence. [edmcasereports.com]

Etiology

Stain for acid fast bacilli and fungal etiologies were negative. The evaluation of etiology and differential diagnosis of granulomatous hypophysitis was done. Tuberculosis was diagnosed. [endocrine-abstracts.org]

This classic histological finding differentiates it from the histological appearances of other etiologies of hypophysitis, those being: lymphocytic hypophysitis : lacks plasma cells and presents in a young female demographic 1,2 granulomatous hypophysitis [radiopaedia.org]

It was reasonably assumed, therefore, that this disease has an auto immune etiology. [pituitaryadenomas.com]

In the absence of any evidence of any local or systemic causes of granulomatous inflammation, an immune etiology has to be considered. [cancerjournal.net]

Perhaps this suggests an underlying and unifying autoimmune etiology for both GH and PCNSV with a common target found in both hypophyseal and vascular tissue. [surgicalneurologyint.com]

Epidemiology

The next and largest section of the book concerns autoimmune thyroid disease, and authors of these chapters take the reader through the basic epidemiology, genetic and environmental risk factors, immunopathogenesis, and the diagnostic and management aspect [books.google.com]

Epidemiology According to the one epidemiological study in Minnesota, there were 94 patients identified with De Quervain’s thyroiditis. This represents an incidence of 12.1 cases per 100,000 people per year. [news-medical.net]

Rose Departments of Pathology (P.C., P.C.B., N.R.R.), Epidemiology (C.N.), Neurosurgery (A.O.), Neuroradiology (M.G.P.), and Molecular Microbiology and Immunology (P.C., N.R.R.), The Johns Hopkins University, Baltimore, Maryland 21205 Diabetes and Endocrine [slideplayer.com]

[…] the two diseases represent an autoimmune spectrum from a purely lymphocytic form constituting the predominant early lesion to a granulomatous form appearing later. 1 Granulomatous hypophysitis, however differs from lymphocytic hypophysitis in certain epidemiological [japi.org]

Granulomatous hypophysitis, however, differs from lymphocytic hypophysitis in certain epidemiological features, which are mostly associated with pregnancy and autoimmune diseases [ 6 ]. [kjim.org]

Pathophysiology

The pathophysiologic process apparently begins as an acute inflammatory response with enlargement of the gland, as noted in 95% tissue-documented cases. [pituitaryadenomas.com]

Prevention

Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. ‎ Página 84 - Tanner JM, Whitehouse RH, Marubini E, Resele LF. The adolescent growth spurt of boys and girls of the Harpenden growth study. ‎ [books.google.es]

[…] surgery is recommended for all cases to aid unequivocal diagnosis, disease specific therapy, rapid decompression and resolution of symptoms, and to obviate unnecessary steroid therapy. [1], [2] Frozen section examination can be done intra-operatively to prevent [ijpmonline.org]

There are valves in most veins to prevent backflow, veins are present throughout the body as tubes that carry blood back to the heart. [wikivisually.com]

The significance of this inflammatory reaction could be that to prevent the extent of the tumor, as reported in several types of malignant neoplasms as part of a spontaneous regression process [ 17 ]; the exclusivity in our case was that pituitary adenomas [omicsonline.org]

We describe a case of Wegener's granulomatosis with granulomatous hypophysitis and suggest possible indications revealed by MR imaging to allow medical management and prevent surgery. [ajnr.org]

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