Primary Non-necrotizing Granulomatous Hypophysitis Mimicking Pituitary Adenomas

Introduction:The authors review their experience in the endoscopic endonasal transsphenoidal treatment of patients with primary hypophysitis assuming that pituitary adenomas.

Material and Method :A retrospective study was undertaken to review 4 cases of primary non-necrotizing granulomatous hypophysitis. The mean age of the patients was 47,5 years and all of them are female. Recent pregnancy and underlying autoimmunity were not noted. Headache, suprasellar mass lesions hormonal deficiency and vision loss were the most common presenting features. The initial presumptive diagnosis was pituitary adenoma in all patients.The endocrinological evalution of the patients were one cushing disease, one prolactinoma, one anterior pituitary deficiency and hyponatremia and the last one is nonsecretory sellar mass. All of the patients have macroadenomas and one of them was invasive adenoma with skull base invasion. Two patients (%50) have visual field defect. All of the patients underwent endoscopic endonasal transsphenoidal surgery(EETS)..

Results :Postoperatively visual fild defects improved in two of the patients, The one who had anterior pituitary deficiency and hyponatremia, required long term hormone replacement postoperatively. The other 3 patients have good hormonal findings postoperatively.There is no complications such as cerebrospinal fluid leak or vascular injury. Follow up of patiens is meanly 11 months.

Conclusions :Primary granulomatous hypophysitis are very rare lessions without known any etiologic factors. They can mimic pituitary adenomas in radiological and endocrinological aspects. EETS was an effective and safe treatment especially for visual and pressure symptoms. There is no postoperative recurrence developed in four patients after surgery mean 11 mounths follow up.