S021

Lymphocytic hypophysitis?

SA Qureshi, R. Kaushal, West Middlesex Hospital.

Case history

We present a 33 year old female who presented to us in her 3rd trimester of her 2nd pregnancy   with shakes involving her hands and legs. Her last pregnancy was unremarkable. She suffered with frontal and hemicranial headaches, which seemed to exacerbate after these episodes. She felt tired after these episodes. Subsequently she developed symptoms of polyuria and polydipsia at 33 weeks of her pregnancy. Her water deprivation test showed that her urine osmolarity stabilised at a lower level. She was initiated on oral Desmopressin 0.1 mg through her pregnancy and her symptoms resolved. Her MRI scan was organized which was reported normal. A clinical diagnosis of lymphocytic hypophysitis was made. Considering her pregnancy pituitary biopsy or surgery was considered not appropriate for her. She is currently 1.5 years post partum and develops osmotic symptoms on withdrawal of Desmopressin in clinic. We have failed to wean her off the treatment.

Conclusions and points for discussion

Lymphocytic hypophysitis is a rare condition, thought to be autoimmune in origin, with a strong predilection for women in the peripartum period. It usually presents with enlarging pituitary mass and variable degrees of hypopituitarism. This case illustrates the difficulty with conservative management of lymphocytic hypophysitis on clinical grounds. What should be next course of action if withdrawal of treatment leads to relapse? Pituitary Biopsy or Surgery?

 

 

Investigations

 

Cortisol

802 n mol/l

T4/TSH

13.6/1.32 pmol/l

IGF 1

77 ng/ml

GH

0.2 ng/ml

Urine osmolarity (m Osm/kg)

 

154

 

112

 

102

 

104  

Desmopressin 0.1 mg

377

 

647

 

656

 

617

 

511

 

625

 

394

 

765