Suspected lymphocytic hypophysitis in a man

Lymphocytic hypophysitis is a rare but increasingly recognised inflammatory disease, considered to be autoimmune. It can involve the anterior and/or posterior lobe of the pituitary gland with corresponding hormone deficiencies. Most cases occur in women, mainly during late pregnancy or the early postpartum period. The diagnosis can be challenging in many cases, because distinction from pituitary adenomas and other sellar masses is not obvious. The therapeutic approach is controversial and, although transphenoidal surgery is often performed, a conservative medical management is justified in many cases, given the self-limited nature of the inflammatory process. We describe a 36-year-old man who was acutely admitted to our hospital because of acute confusion. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and negative viral serology. Magnetic resonance imaging (MRI) demonstrated an enlarged pituitary gland with homogeneous enhancement, post contrast. The endocrinologic data indicated impaired secretion of ACTH and gonadotropin, associated with thyroiditis