Acute Onset of Polyarthralgia and High Anti-Cyclic Citrullinated Peptide Antibodies in a Case of Idiopathic Granulomatous Hypophysitis

Postpartum granulomatous hypophysitis with sphenoid sinus involvement: a case study

OBJECTIVE

To report an unusual case of granulomatous hypophysitis with sphenoid sinus involvement in a woman presenting with headaches and visual field deficits approximately 2 weeks after a normal delivery.

METHODS

We present the history, physical findings, hormonal assay results, pituitary imaging, surgical findings, and pathology findings at presentation and then follow-up data at several times encompassing 1 year of observation. We also performed a literature review on granulomatous hypophysitis.

RESULTS

A 29-year-old woman presented with headache and visual disturbances 11 days after childbirth. Magnetic resonance imaging revealed a sellar mass with suprasellar extension, compression of the optic chiasm, possible invasion of the cavernous sinuses, and sinus mucosal thickening. A subtotal resection was performed through the transsphenoidal route. Histologic examination demonstrated extensive nonvasculitic granulomatous tissue in pituitary and sphenoid mucosal samples. Investigation for known causes of granulomatous hypophysitis was negative. She required desmopressin and levothyroxine replacement postoperatively. Sequential follow-up revealed spontaneous resolution of the residual mass in 5 months.

CONCLUSION

Unique features of this case include the concomitant presence of granulomatous lesions in the pituitary gland and the sphenoid sinus, its manifestation in the early postpartum period, and the spontaneous resolution of the residual granulomatous lesions in both the sphenoid sinus and the sella turcica.