Yang MG, Cai HQ, Wang SS, Liu L, Wang CM. Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report. World J Clin Cases 2022; 10(3): 1041-1049 [PMID: 35127918 DOI: 10.12998/wjcc.v10.i3.1041]
Corresponding Author of This Article
Chun-Mei Wang, MA, Chief Doctor, Department of Radiology, The First Hospital of Jilin University, No. 1 Xinmin Avenue, Changchun 130000, Jilin Province, China. wangcm5413@jlu.edu.cn
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 21, 2022; 10(3): 1041-1049 Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.1041
Full recovery from chronic headache and hypopituitarism caused by lymphocytic hypophysitis: A case report
Mao-Guang Yang, Han-Qing Cai, Si-Si Wang, Lin Liu, Chun-Mei Wang
Mao-Guang Yang, Han-Qing Cai, Si-Si Wang, Lin Liu, Department of Endocrinology, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
Chun-Mei Wang, Department of Radiology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Author contributions: Wang CM analyzed and interpreted the imaging findings and contributed to the manuscript drafting; Cai HQ contributed to the data curation and proofreading of the manuscript; Wang SS and Liu L were responsible for revising the manuscript for important intellectual content; Yang MG reviewed the literature; Wang CM and Yang MG contributed to the manuscript drafting; and all authors read and approve of the final manuscript.
Supported bythe Nature Science Foundation of Jilin Province (No. 2018010113JC).
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Mei Wang, MA, Chief Doctor, Department of Radiology, The First Hospital of Jilin University, No. 1 Xinmin Avenue, Changchun 130000, Jilin Province, China. wangcm5413@jlu.edu.cn
Received: June 16, 2021 Peer-review started: June 16, 2021 First decision: June 25, 2021 Revised: July 5, 2021 Accepted: December 25, 2021 Article in press: December 25, 2021 Published online: January 21, 2022
Abstract
BACKGROUND
Lymphocytic hypophysitis (LYH) is an important condition to consider in the differential diagnosis of patients with a pituitary mass. The main clinical manifestations of LYH include headache, symptoms related to sellar compression, hypopituitarism, diabetes insipidus and hyperprolactinemia. Headache, which is a frequent complaint of patients with LYH, is thought to be related to the occupying effect of the pituitary mass and is rapidly resolved with a good outcome after timely and adequate glucocorticoid treatment or surgery.
CASE SUMMARY
Here, we report a patient with LYH whose initial symptom was headache and whose pituitary function assessment showed the presence of secondary hypoadrenalism, central hypothyroidism and hypogonadotropic hypogonadism. Pituitary magnetic resonance imaging showed symmetrical enlargement of the pituitary gland with suprasellar extension in a dumbbell shape with significant homogeneous enhancement after gadolinium enhancement. The size of the gland was approximately 17.7 mm × 14.3 mm × 13.8 mm. The pituitary stalk was thickened without deviation, and there was an elevation of the optimal crossing. The lesion grew bilaterally toward the cavernous sinuses, and the parasternal dural caudal sign was visible. The patient presented with repeatedly worsening and prolonged headaches three times even though the hypopituitarism had fully resolved after glucocorticoid treatment during this course.
CONCLUSION
This rare headache regression suggests that patients with chronic headaches should also be alerted to the possibility of LYH.
Core Tip: Lymphocytic hypophysitis (LYH) is an important condition to consider in the differential diagnosis of patients with a pituitary mass, and headache is a frequent complaint of patients with LYH. We present a patient with LYH whose initial symptom was headache and who presented with repeatedly worsening and prolonged headaches three times even though the hypopituitarism was fully resolved after glucocorticoid treatment. This rare headache regression suggests that the cause of headaches in patients with LYH may not be exclusively due to the pituitary mass effect and that patients with chronic headaches should also be alerted to the possibility of LYH.
