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Lymphocytic hypophysitis presenting as a visual threatening sellar mass and its complete recovery with oral steroids: think beyond surgery

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Author(s): Pramila Dharmshaktu | Mahaveer Singh | Dinesh Dhanwal

Journal: Endocrinology Studies
ISSN 2038-9515

Volume: 3;
Issue: 2;
Start page: e9;
Date: 2013;
Original page

Keywords: lymphocytic hypophysistis | hypothyroidism | steroids

ABSTRACT
A 37-years female patient presented to us with hypothyroidism. She was started on oral thyroid replacement and sent back to home. Four weeks later she again came with history of progressive vision loss and headache. Ophthalmological evaluation revealed bitemporal hemianopia with bilateral papilloedema. Non-contrast computed tomography revealed mass lesion in pituitary fossa. Hormone profile showed secondary hypocortisolism and secondary hypothyroidism. Magnetic resonance imaging (MRI) brain showed diffusely enlarged sellar mass with suprasellar extension with enhancement of both anterior, posterior pituitary andinfundibulam. Neurologist advised urgent surgical intervention. A diagnosis of lymphocytic hypophysitis was made based on clinical and radiological evidences and surgery was deferred. Patient was given oral steroid on OPD basis and she improved dramatically. The mass also vanished subsequently on follow up MRI brain. This case illustrates the potential benefit of trial of medical management when there is a strong possibility even with vision loss due to mass effect in lymphocytic hypophysitis.
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