1/7. Lymphocytic hypophysitis: report of an unusual case of a rare disorder.A 36-year-old non-pregnant woman presented with a four-month history of progressive visual deterioration and amenorrhea. The latest gestation was 6 years earlier. Hormonal study revealed central diabetes insipidus, hypopituitarism, and slightly increased prolactin level. Ophthalmologic examination showed bilateral hemianopsia. In the magnetic resonance imaging an intrasellar mass with supra and retrosellar extension was found. The mass showed a polylobular aspect with heterogeneous signal within the tissue. The normal neurohypophysis could not be identified. Pterional craniotomy was performed. The pathological examinations revealed fibrous tissue with heavy inflammatory infiltrate composed of lymphocytes and plasma cells, islands of eosinophilic epithelial cells stained positively for chromogranin, GH, ACTH, and PRL and negatively for antibodies directed against HLA-II antigens. This case of lymphocytic hypophysitis was not related to pregnancy and involved the neurohypophysis. We discuss the features that can help to make a preoperative differential diagnosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/7. Hypophyseal hemorrhage and panhypopituitarism during puumala virus infection: magnetic resonance imaging and detection of viral antigen in the hypophysis.We describe 3 cases of nephropathia epidemica (NE) that confirm that puumala virus infection may cause hypophyseal injury. autopsy revealed a hemorrhagic hypophysis positive for puumala virus antigen in both neuroendocrine stromal and vascular endothelial cells in 1 patient, and 2 patients developed hypophyseal hemorrhage (diagnosed with magnetic resonance imaging) during or shortly after acute NE, both of whom developed panhypopituitarism.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
3/7. A case of autoimmune hypophysitis associated with Graves' disease.In a 76-year-old woman with hyperthyroidism, hyperprolactinemia and thickening of the pituitary stalk on magnetic resonance imaging (MRI) was presented. Thyroid stimulating antibody (TSAb) was positive and anti-pituitary antibodies against 49 and 68 kD human anterior pituitary membrane antigens were detected immunologically. Secretion of pituitary hormones was almost normal except for suppressed TSH and hyperprolactinemia. As autoimmune etiologies were likely involved in the disorders, autoimmune hypophysitis associated with Graves' disease was arrived at as the plausible diagnosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/7. Lymphocytic adenohypophysitis presenting as infertility. Case report.The authors report a nulliparous patient presenting with infertility and hyperprolactinemia. She underwent transsphenoidal surgery after radiological investigation disclosed an enlarged pituitary gland which did not respond to bromocriptine therapy. The removed tissue had histological features consistent with adenohypophysitis including a diffuse lymphocytic infiltrate. The lymphocyte subsets present in the infiltrate were characterized by immunohistochemical methods to establish the contribution of different elements of the cellular immune response. lymphocytes bearing CD4 antigen (helper-inducer cells) were most prominent and appeared to bear the majority of the interleukin-2 receptor (expressed during lymphocytic activation) present in the pituitary gland. A few B lymphocytes were also observed. The location of the major histocompatibility antigen (classes I and II) and interleukin-2 receptor correlated with the lymphocytes and macrophages rather than with the stromal or parenchymal elements of the pituitary. Lymphocytic adenohypophysitis is an unusual cause of pituitary enlargement which can mimic a pituitary tumor, and is sometimes associated with hyperprolactinemia. In women of child-bearing age, it almost always occurs during pregnancy or the postpartum stage. The autoimmune disorder reported here has not previously been associated with infertility nor has the lymphocytic infiltrate of the pituitary previously been analyzed in detail by modern immunological methods.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
5/7. Reports of two cases of selective adrenocorticotropin (ACTH) and growth hormone (GH) deficiency: differential diagnosis from cases with isolated ACTH deficiency associated with transient GH insufficiency.An acquired partial pituitary insufficiency with selective ACTH and GH deficiency was demonstrated in two men aged 47 and 54, for which the clinical course over many years corresponds to Addison's disease. In one of the 2 cases, antibodies to anterior pituitary cell membrane, assayed by an immunofluorescence method with GH3 cells (rat GH and prolactin secreting cell) and AtT-20 cells (mouse ACTH secreting cell) as antigens, were positive. We also present a 55-year-old man with isolated ACTH deficiency associated with transient GH deficiency. In this case, hydrocortisone replacement corrected his subnormal, pre-therapy GH response to insulin tolerance and glucagon propranolol tests, although there was no response of serum GH to L-dops and arginine stimulation test before therapy. Selective ACTH and GH deficiency are very rare and the finding of transient GH insufficiency in a patient with isolated ACTH deficiency suggests that repeated testing while on hydrocortisone replacement therapy is of great diagnostic importance in order to distinguish between selective ACTH and GH deficiency and isolated ACTH deficiency accompanied by transient GH insufficiency.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/7. A case of hypopituitarism due to granulomatous and lymphocytic adenohypophysitis with minimal pituitary enlargement: a possible variant of lymphocytic adenohypophysitis.A 47-year-old woman complaining of cold intolerance, general weakness and amenorrhea of 10 months duration was diagnosed, by endocrine examinations, as having panhypopituitarism. skull x-ray films revealed a slightly enlarged sella with double floor sign and MRI showed a low intensity mass in the pituitary. Transsphenoidal exploration disclosed a degenerated pituitary gland, the histology of which showed a granulomatous lesion with moderate lymphocytic infiltration but containing no multinuclear giant cells. No caseous necrosis, causative microorganisms, or BCG antigen were noted. The present case is considered a variant form of lymphocytic adenohypophysitis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/7. Pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroid alone: first case report.We report the first case of pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroids without surgery. A 27-year-old woman had been monitored for chronic headache 13 months after giving birth, associated with amenorrhea and galactorrhea. Cranial magnetic resonance imaging revealed a markedly enlarged pituitary gland with a suprasellar extension; the only biochemical abnormality was a mild hyperprolactinemia. Because of a putative diagnosis of prolactinoma, bromocriptine was prescribed at a dose of 5 mg daily, soon followed by the transitory appearance of menstruation. Two years later, panhypopituitarism was present and was revealed by acute adrenal insufficiency. magnetic resonance imaging revealed that the pituitary mass was the same as previously described, but hormonal investigation showed evidence of complete hypopituitarism and no hyperprolactinemia. Nuclear antibodies were negative as well as other autoantibodies. Human leukocyte antigen serological Class II typing was DR3/DR4. Lymphocytic hypophysitis was then suspected; in the absence of visual complication and because this patient refused surgery, corticosteroids were attempted at a daily dose of 60 mg of prednisone for 3 months, progressively decreased for the next 6 months. Under this treatment, a gradual recovery of all pituitary hormones was observed and magnetic resonance imaging showed a reduction of two-thirds in pituitary mass. Five months after the end of corticoid treatment, our patient relapsed with panhypopituitarism and an increase of pituitary volume. She underwent steroid treatment, and a biopsy was performed and confirmed the diagnosis of autoimmune hypophysitis.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |