Case Report:Granulomatous hypophysitis:two case reports and literature review

作     者：Jian SHI Jian-min ZHANG Qun WU Gao CHEN Hong ZHANG Wen-liang BO 

作者机构：Department of Neurosurgepy the Second Affiliated Hospital School of Medicine Zhejiang University Hangzhou 310003 China Department of Neurosurgery Suichang People's Hospital Suichang 323000 China 

出 版 物：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 (浙江大学学报（英文版）B辑（生物医学与生物技术）)

年 卷 期：2009年第10卷第7期

页      面：552-558页

核心收录：

学科分类：090603[农学-临床兽医学] 09[农学] 0906[农学-兽医学] 

主　　题：Granulomatous hypophysitis Steroid treatment Imageology Trans-sphenoidal surgery 

摘      要：Granulomatous hypophysitis （GRH） is extremely rare and commonly presents with chronic inflammatory of the enlarged pituitary gland. In our study, 66-year-old and 57-year-old women, both Chinese, were diagnosed with GRH presenting preoperatively definite imageology characters as pituitary adenoma. The 66-year-old woman presented with a year of headache, half a year of gradual decrease of visual acuity, and one month of right ptosis. Serum prolaetin level was slightly elevated. Screening computed tomography （CT） scanning revealed typical low density mass found on the enlarged sella, which demonstrated invasive extension from the sella to the right cavernous sinus by contrast enhanced magnetic resonance imaging （MRI）. Consequently, the patient was diagnosed with probable invasive pituitary adenoma. The other 57-year-old woman complained a light headache and had been previously treated as nonfunctional pituitary adenoma in other hospital. Finally these two patients underwent transsphenoidal microsurgery and were diagnosed with GRH according to postoperative histopathology. They then were treated with steroid. During the follow-up, the clinical symptoms such as headache, visual damage, and ptosis vanished, and the mass of the sellae dramatically shrank on repeated MR images. Clinically and radiologically, GRH is a rare sellar entity easily to be misdiagnosed as a pituitary adenoma. Trans-sphenoidal surgery can decompress the optical nerve or oculomotornerve as a therapeutic strategy, and support biopsy or further pathological diagnosis. However, the hormonal therapy should be emphasized both as diagnostic and therapeutic strategies. Conservative and tentative steroid treatment should be performed in preoperative period without acute nerve damage.