Endocrinol Metab.  2010 Dec;25(4):347-353. 10.3803/EnM.2010.25.4.347.

A Case of Giant Cell Granulomatous Hypophysitis with Recurrent Hypoosmolar Hyponatremia

• Lee YH
• Kim YB
• Lee JH
• Jeong KH
• Kim MK
• Song KS
• Jo YS

• KMID: 1497761
• DOI: http://doi.org/10.3803/EnM.2010.25.4.347

Abstract

A 39-year-old woman presented with a 20 day history of recurrent hypoosmolar hyponatremia. Because her volume status seemed to be normal, the most suspected causes of her hyponatremia were adrenal insufficiency and hypothyroidism. Endocrinologic examination, including a combined pituitary function test, showed TSH and ACTH deficiency without GH deficiency, and hyperprolactinemia was also present. Sella MRI showed a pituitary mass, stalk thickening and loss of the normal neurohypophysial hyperintense signal on the T1 weighted image. Pathologic exam demonstrated granulomatous lesions and Langhans' multinucleated giant cells with inflammatory cell infiltration. After high dose methylprednisolone pulse therapy (1 g/day for 3 days) with subsequent prednisolone and levothyoxine replacement, there was no more recurrence of the hyponatremia. The sella MRI on the 6th month showed decreased mass size, narrowed stalk thickening and the reappearance of the normal neurohyphophysial hyperintense signal. She is currently in a good general condition and is receiving hormone replacement therapy.

Keyword

Granulomatous hypophysitis; Hypoosmolar hyponatremia; Methylprednisolone pulse therapy

MeSH Terms

Adrenal Insufficiency
Adrenocorticotropic Hormone
Adult
Female
Giant Cells
Hormone Replacement Therapy
Humans
Hyperprolactinemia
Hyponatremia
Hypothyroidism
Methylprednisolone
Pituitary Function Tests
Prednisolone
Recurrence
Adrenocorticotropic Hormone
Methylprednisolone
Prednisolone

Figure

• 

  Fig. 1 (A, B) T1-wieghted image of the sella MRI shows homogenously contrast-enhanced soft tissue mass with enlarged pituitary stalk (arrows and arrowheads, respectively). Notice the non-visualization of T1-high signal intensity of the neurohypophysis. (C, D) Follow up MRI of 6 month after High Dose Methylprednisolone Pulse Therapy and prednosolone replacement: Notice the decreased size of remained pituitary mass and improved pituitary stalk thickening (arrows and arrowheads, respectively) with faintly reappeared hyperintense neurohypophysial signal (see the boxed area on right upper part in C).

• 

  Fig. 2 (A, B) The histologic finding of the inflammatory pituitary tissue. Notice a granulomatous lesion (arrows on A) and Langhans' multinucleated giant cell (arrows on B) with lymphocyte infiltration (H&E stain, × 200: A, × 400: B).

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