Lymphocytic hypophysitis
Updates to Article Attributes
Lymphocytic hypophysitis (LH)is an uncommon non-neoplastic inflammatory condition that affects the pituitary gland. It is closely related to other inflammatory conditions in the region, namely orbital pseudotumour and Tolosa-Hunt syndrome.
Epidemiology
Lymphocytic hypophysitis is seen most frequently in women (strong female predilection, with a F:M of ~ 9:1), and often in the postpartum period or the third trimester of pregnancy.
Clinical presentation
Clinical presentation is varied depends on the part of the pituitary affected and the size of the lesion. Lymphocytic hypophysitis can thus be classified as:
- anterior pituitary: lymphocytic adenohypophysitis
(LAH)- most common
- mimics a pituitary adenoma
- endocrine hormone deficits are common, including hypopituitarism
- mass effects on adjacent structures (e.g. optic chiasm)
- posterior pituitary: lymphocytic infundibular neurohypophysitis
(LINH)- rare
- diabetes insipidus
- both anterior and posterior pituitary: lymphocytic infudibular panhypophysitis
(LIPH)
Associations
-
auto-immune conditions such as ipilimumab: monoclonal antibody drug
Pathology
It is characterised by infiltration of the pituitary stalk with lymphocytes, as the name would suggest. Importantly, there is a paucity of plasma cells or granulomas, differentiating it from IgG4-related hypophysitis and granulomatous hypophysitis (e.g. due to neurosarcoidosis) respectively.
Associations
- auto-immune conditions such as
- ipilimumab: monoclonal antibody drug
Radiographic features
CT
Coronal CT and multiplanar reconstructions can visualise the pituitary region reasonably well. Lymphocytic hypophysitis appears as an enhancing soft tissue mass involving the pituitary and extending into the suprasellar region.
MRI
MRI, as is the case with other pituitary lesions, is the best modality for assessing this condition which appears as a pituitary region mass.
-
T1
- affected area is isointense with slight signal heterogeneity
- normal posterior pituitary bright spot may be absent 8
-
T1 C+ (Gd)
- can variably enhance, usually homogeneously 7
- dural enhancement may be present 8
- infundibulum may be thickened 8
-
T2
- hypointensity in parasellar region can be present and may be useful in differentiating from a pituitary adenoma 4
Treatment and prognosis
Lymphocytic hypophysitis is usually self-limiting and spontaneous recovery can occur. Corticosteroids are sometimes given and deficient hormones can be replaced 8.
Differential diagnosis
The differential diagnosis is primarily that of other pituitary region masses. Considerations include:
-
pituitary adenoma
- macroadenomas are expected to enlarge the sella turcica
- craniopharyngioma (papillary type)
- suprasellar meningioma
- dural based aspect
- usually follows the cerebral cortex intensity
- pituitary metastasis
- IgG4-related hypophysitis
- granulomatous hypophysitis (idiopathic of secondary to systemic illness e.g. sarcoidosis, syphilis, and tuberculosis)
- xanthomatous hypophysitis
- necrotising hypophysitis
-<p><strong>Lymphocytic hypophysitis (LH)</strong> is an uncommon non-neoplastic inflammatory condition that affects the pituitary gland. It is closely related to other inflammatory conditions in the region, namely <a href="/articles/orbital-pseudotumour">orbital pseudotumour</a> and <a href="/articles/tolosa-hunt-syndrome-3">Tolosa-Hunt syndrome</a>.</p><h4>Epidemiology</h4><p>Lymphocytic hypophysitis is seen most frequently in women (strong female predilection with a F:M of ~ 9:1), and often in the postpartum period or the third trimester of pregnancy.</p><h4>Clinical presentation</h4><p>Clinical presentation is varied depends on the part of the pituitary affected and the size of the lesion. Lymphocytic hypophysitis can thus be classified as:</p><ul>-<li>anterior pituitary: lymphocytic adenohypophysitis (LAH)<ul>- +<p><strong>Lymphocytic hypophysitis </strong>is an uncommon non-neoplastic inflammatory condition that affects the pituitary gland. It is closely related to other inflammatory conditions in the region, namely <a href="/articles/idiopathic-orbital-inflammation">orbital pseudotumour</a> and <a href="/articles/tolosa-hunt-syndrome-3">Tolosa-Hunt syndrome</a>.</p><h4>Epidemiology</h4><p>Lymphocytic hypophysitis is seen most frequently in women, with a F:M of ~ 9:1, and often in the postpartum period or the third trimester of pregnancy.</p><h4>Clinical presentation</h4><p>Clinical presentation is varied depends on the part of the pituitary affected and the size of the lesion. Lymphocytic hypophysitis can thus be classified as:</p><ul>
- +<li>anterior pituitary: lymphocytic adenohypophysitis<ul>
-<li>posterior pituitary: lymphocytic infundibular neurohypophysitis (LINH)<ul>- +<li>posterior pituitary: lymphocytic infundibular neurohypophysitis<ul>
-<li>both anterior and posterior pituitary: lymphocytic infudibular panhypophysitis (LIPH)</li>-</ul><h4>Associations </h4><ul>- +<li>both anterior and posterior pituitary: lymphocytic infudibular panhypophysitis</li>
- +</ul><h4>Pathology</h4><p>It is characterised by infiltration of the <a href="/articles/pituitary-stalk">pituitary stalk</a> with lymphocytes, as the name would suggest. Importantly, there is a paucity of plasma cells or granulomas, differentiating it from <a href="/articles/igg4-related-hypophysitis">IgG4-related hypophysitis</a> and <a href="/articles/granulomatous-hypophysitis">granulomatous hypophysitis</a> (e.g. due to <a href="/articles/neurosarcoidosis">neurosarcoidosis</a>) respectively.</p><h5>Associations</h5><ul>
-</ul><h4>Pathology</h4><p>It is characterised by infiltration of the <a href="/articles/pituitary-stalk">pituitary stalk</a> with lymphocytes, as the name would suggest. Importantly, there is a paucity of plasma cells or granulomas, differentiating it from <a href="/articles/igg4-related-hypophysitis">IgG4-related hypophysitis</a> and <a href="/articles/granulomatous-hypophysitis">granulomatous hypophysitis</a> (e.g. due to <a href="/articles/neurosarcoidosis">neurosarcoidosis</a>) respectively.</p><h4>Radiographic features</h4><h5>CT</h5><p>Coronal CT and multiplanar reconstructions can visualise the pituitary region reasonably well. Lymphocytic hypophysitis appears as an enhancing soft tissue mass involving the pituitary and extending into the suprasellar region.</p><h5>MRI</h5><p>MRI, as is the case with other pituitary lesions, is the best modality for assessing this condition which appears as a <a href="/articles/pituitary-region-masses">pituitary region mass</a>.</p><ul>- +</ul><h4>Radiographic features</h4><h5>CT</h5><p>Coronal CT and multiplanar reconstructions can visualise the pituitary region reasonably well. Lymphocytic hypophysitis appears as an enhancing soft tissue mass involving the pituitary and extending into the suprasellar region.</p><h5>MRI</h5><p>MRI, as is the case with other pituitary lesions, is the best modality for assessing this condition which appears as a <a href="/articles/pituitary-region-masses">pituitary region mass</a>.</p><ul>
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