Lymphocytic hypophysitis

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Lymphocytic hypophysitis (lymphocytic infundibulohypophysitis) is an autoimmune disease directed at the pituitary seen most often in women in pregnancy or after delivery. Viral illness may preceed (eg Puumala hantavirus (PUUV) and other hantavirus)[1]. It has also been described as a side effect of ipilimumab[2] or nivolumab[3], rupture of Rathke's cleft cysts[4] and IgG4-related disease[5]. It is a cause of hypopituitarism.

Diagnosis

Pituitary gland biopsies can reveal perivascular mast cells and lymphoplasmacytic infiltration surrounding atrophic acini. The histology is distinct from that of granulomatous or xanthomatous hypophysitis. The involvement of the posterior lobe and pituitary stalk may result in diabetes insipidus as a clinical sign. MRI may show disappearance of hyperintensity signals on T1-weighted images.

References

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