PDF(Pubmed)
Abstract：
Hypophysitis is an extremely rare inflammatory disease that can mimic the clinical and radiological features of a pituitary adenoma. In this case report, we describe a 45-year-old woman with secondary xanthogranulomatous hypophysitis (XGH) who presented with signs of a pituitary macroadenoma. The patient complained of headaches, visual impairment, and amenorrhea-galactorrhea syndrome. Her physical examination was normal. Laboratory investigation revealed corticotropin, thyrotropin, and gonadotropin deficiencies. She also had low visual acuity in her right eye and an altered visual field. Pituitary magnetic resonance imaging revealed an intra and suprasellar mass measuring 13 × 11 × 16 mm, with hemorrhagic necrosis, that was having a discrete mass effect on the patient\'s optic chiasm and pituitary stalk. The patient was treated with hydrocortisone and levothyroxine, and then transferred to the Neurosurgery department for total transsphenoidal resection of the mass. Histological examination of the tumor permitted a diagnosis of XGH of a remodeled Rathke\'s pouch cyst to be made. Systemic conditions such as tuberculosis, sarcoidosis, and other granulomatous diseases were excluded. The etiopathogenesis of XGH remains poorly characterized, but it may be a progressive form of lymphocytic hypophysitis or a remodeled Rathke\'s pouch cyst. Screening for autoimmune pathology and systemic diseases is essential to guide appropriate management.
摘要：
垂体炎是一种极其罕见的炎症性疾病，可以模仿垂体腺瘤的临床和放射学特征。在这个案例报告中,我们描述了一名45岁女性,患有继发性黄色肉芽肿性垂体炎(XGH),表现为垂体大腺瘤.病人抱怨头痛，视力障碍，闭经-溢乳综合征.体检正常。实验室调查显示促肾上腺皮质激素，促甲状腺激素,和促性腺激素缺乏。她的右眼视力也很低，视野也改变了。垂体磁共振成像显示鞍内和鞍上肿块13×11×16mm，伴有出血性坏死,这对患者的视交叉和垂体柄有离散的质量影响。患者接受了氢化可的松和左甲状腺素治疗,然后转到神经外科进行全蝶窦切除。肿瘤的组织学检查允许对重塑的Rathke囊囊肿进行XGH诊断。系统性疾病，如结核病，结节病,排除其他肉芽肿性疾病。XGH的病因仍然不明确，但它可能是淋巴细胞性垂体炎的进行性形式或重塑的Rathke囊囊肿。筛查自身免疫性病理学和全身性疾病对于指导适当的管理至关重要。
