Infundibulo-hypophysitis: A Case Diagnosed by Magnetic Resonance Images Over Time, with Literature Review

Case Report

Austin J Endocrinol Diabetes. 2014;1(5): 1025.

Infundibulo-hypophysitis: A Case Diagnosed by Magnetic Resonance Images Over Time, with Literature Review

Ningning Hou, Chunyan Wang, Xue Liu, Xiaodong Sun*

Department of Endocrinology, Affiliated Hospital of Weifang Medical University, China

*Corresponding author: Xiaodong Sun, Department of Endocrinology, Affiliated Hospital of Weifang Medical University, China

Received: August 18, 2014; Accepted: September 20, 2014; Published: September 25, 2014

Abstract

Infundibulo-hypophysitis is a rare type of autoimmune hypophysitis that involves the pituitary stalk and pituitary. It currently has no clear diagnostic criteria, and is often misdiagnosed as pituitary tumor, leading to unnecessary surgery. Here, we present a 50-year-old woman with in fundibulo-hypophysitis who was diagnosed using multiple magnetic resonance images taken over several months at follow-up. We discuss the course of her disease and her treatment, the imaging features of infundibulo-hypophysitis and similar diseases, and review the relevant literature.

Keywords: Pituitary; Auto-immune disease; Diagnosis

Introduction

Infundibulo-hypophysitis (IH) has no clear diagnostic criteria as of yet. As its clinical manifestations are similar to those of pituitary tumor, hypophysitis is often misdiagnosed as pituitary tumor, which can lead to unneeded surgical treatment [1–3]. Imaging helps to diagnose and treat IH, but its details are rarely described in the literature. Here, we describe a case that used magnetic resonance imaging (MRI) over several months to track changes in autoimmune IH and diagnose it at follow-up, and we review the pertinent literature.

Case Presentation

In August 2012, our patient, a 50-year-old woman, began to display polydipsia, polyuria, nausea, vomiting and other symptoms for no apparent reason; her daily water intake was about 4L, with nocturia 5–6 times/d, weight loss of about 10 kg, and blurred vision in her right eye. She had experienced amenorrhea for half a year. She had no previous history of hypothalamus or pituitary surgery. In October 2012, examination at our hospital showed: temperature: 35.6 °C; pulse: 84 /min; blood pressure: 107/81 mmHg; and BMI 23.3kg/ m2, with no binocular visual field defect, some right eye visual loss, systemic rough skin, no thyroid enlargement, no hair change and no abnormalities in heart, lung or abdomen. Her laboratory results showed urine specific gravity: <1.010; blood electrolytes and blood glucose are in Table 1, endocrine related hormones are in Table 2, no abnormal liver and kidney functions; tumor markers CA-199: 30U/ mL, CA-125: 17.2IU/mL, AFP: 5.63ng/ml, antinuclear antibodies-, water deprivation-vasopressin+.

The first pituitary MRI results (Figure1A, B) were equivocal. Although we did not exclude pituitary adenoma, after considering the clinical manifestations and auxiliary examination results, our initial differential diagnosis was hypopituitarism or IH. The patient was given experimental corticosteroid immunosuppressive therapy and replacement therapy. For 9 days, the patient complained of polydipsia and polyuria, but her nausea was significantly reduced. Her retested laboratory results were urine specific gravity: 1.012; free T3: 2.86 pmol/l; free T4: 0.61ng/dl; thyroid stimulating hormone: 1.04 uIU/ ml; and prolactin (PRL): 1.74 ng/ml (bromocriptine:1.25mg/d × 3d). Her blood electrolytes returned to normal, so she was discharged with continuing replacement therapy outside the hospital.