Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy

Hamad Haider Khan; Hameed Ullah; Hui Guo; Siraj Ulhaq Khan; Shida Hussain; Zahid Nadeem; Faiz Ullah Khan; Ayesha Jamil; Nawab Ali; Irfan Mansha; Safiullah Khan Achakzai; Mirwais Khan; Khan Alam; Bingyin Shi

doi:doi:10.11648/j.ajlm.20210606.11

Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy

Hamad Haider Khan, Hameed Ullah, Hui Guo, Siraj Ulhaq Khan, Shida Hussain, Zahid Nadeem, Faiz Ullah Khan, Ayesha Jamil, Nawab Ali, Irfan Mansha, Safiullah Khan Achakzai, Mirwais Khan, Khan Alam, Bingyin Shi

Published in American Journal of Laboratory Medicine (Volume 6, Issue 6)

Received: 12 October 2021 Accepted: 30 October 2021 Published: 17 November 2021

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Abstract

Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation: A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion: lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.

Published in	American Journal of Laboratory Medicine (Volume 6, Issue 6)
DOI	10.11648/j.ajlm.20210606.11
Page(s)	83-87
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Lymphocytic Infiltration, Pan-hypopituitarism, Pituitary Gland

References

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[2]	Faje, A., Hypophysitis: Evaluation and Management. Clinical diabetes and endocrinology, 2016. 2: p. 15-15.
[3]	Glezer, A. and M. D. Bronstein, Pituitary autoimmune disease: nuances in clinical presentation. Endocrine, 2012. 42 (1): p. 74-9.
[4]	Beressi, N., et al., Pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroid alone: first case report. Neurosurgery, 1994. 35 (3): p. 505-8; discussion 508.
[5]	Ozbey, N., et al., An intrasellar germinoma with normal cerebrospinal fluid beta-HCG concentrations misdiagnosed as hypophysitis. Hormones, 2006. 5 (1): p. 67.
[6]	Annamaria, D. B., et al., Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan's syndrome. European Journal of Endocrinology, 2008. 158 (2): p. 147-52.
[7]	Goudie, R. B. and P. H. Pinkerton, Anterior hypophysitis and hashimoto's disease in a young woman. The Journal of Pathology and Bacteriology, 1962. 83 (2): p. 584-585.
[8]	Takahashi, Y., Autoimmune hypophysitis: new developments. Handbook of Clinical Neurology, 2014. 124 (124C): p. 417.
[9]	Fukuoka, H., Hypophysitis. Endocrinology & Metabolism Clinics of North America, 2015. 44 (1): p. 143-149.
[10]	Kartal, I., et al., Lymphocytic panhypophysitis in a young man with involvement of the cavernous sinus and clivus. Pituitary, 2007. 10 (1): p. 75.
[11]	Gellner, V., et al., Lymphocytic hypophysitis in the pediatric population. Childs Nerv Syst, 2008. 24 (7): p. 785-792.
[12]	Falorni, A., et al., Diagnosis and classification of autoimmune hypophysitis. Autoimmunity Reviews, 2014. 13 (4-5): p. 412-416.
[13]	Yamagami, K., et al., Treatment of lymphocytic hypophysitis by high-dose methylprednisolone pulse therapy. Internal Medicine, 2003. 42 (2): p. 168-73.
[14]	Leung, G. K., et al., Primary hypophysitis: a single-center experience in 16 cases. Journal of Neurosurgery, 2004. 101 (2): p. 262-271.
[15]	Laws, E. R., M. L. Vance, and J. A. J. Jr, Hypophysitis. Pituitary, 2006. 9 (4): p. 331-333.
[16]	Caputo, C., et al., Hypophysitis due to IgG4-related disease responding to treatment with azathioprine: an alternative to corticosteroid therapy. Pituitary, 2014. 17 (3): p. 251-256.
[17]	Bellis, A. D., et al., Detection of antipituitary and antihypothalamus antibodies to investigate the role of pituitary or hypothalamic autoimmunity in patients with selective idiopathic hypopituitarism. Clinical Endocrinology, 2011. 75 (3): p. 361-366.
[18]	Minniti, G., M. F. Osti, and M. Niyazi, Target delineation and optimal radiosurgical dose for pituitary tumors. Radiation Oncology, 2016. 11 (1): p. 135.

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APA Style

Hamad Haider Khan, Hameed Ullah, Hui Guo, Siraj Ulhaq Khan, Shida Hussain, et al. (2021). Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy. American Journal of Laboratory Medicine, 6(6), 83-87. https://doi.org/10.11648/j.ajlm.20210606.11

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ACS Style

Hamad Haider Khan; Hameed Ullah; Hui Guo; Siraj Ulhaq Khan; Shida Hussain, et al. Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy. Am. J. Lab. Med. 2021, 6(6), 83-87. doi: 10.11648/j.ajlm.20210606.11

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AMA Style

Hamad Haider Khan, Hameed Ullah, Hui Guo, Siraj Ulhaq Khan, Shida Hussain, et al. Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy. Am J Lab Med. 2021;6(6):83-87. doi: 10.11648/j.ajlm.20210606.11

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@article{10.11648/j.ajlm.20210606.11,
  author = {Hamad Haider Khan and Hameed Ullah and Hui Guo and Siraj Ulhaq Khan and Shida Hussain and Zahid Nadeem and Faiz Ullah Khan and Ayesha Jamil and Nawab Ali and Irfan Mansha and Safiullah Khan Achakzai and Mirwais Khan and Khan Alam and Bingyin Shi},
  title = {Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy},
  journal = {American Journal of Laboratory Medicine},
  volume = {6},
  number = {6},
  pages = {83-87},
  doi = {10.11648/j.ajlm.20210606.11},
  url = {https://doi.org/10.11648/j.ajlm.20210606.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20210606.11},
  abstract = {Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation: A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion: lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.},
 year = {2021}
}

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TY  - JOUR
T1  - Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy
AU  - Hamad Haider Khan
AU  - Hameed Ullah
AU  - Hui Guo
AU  - Siraj Ulhaq Khan
AU  - Shida Hussain
AU  - Zahid Nadeem
AU  - Faiz Ullah Khan
AU  - Ayesha Jamil
AU  - Nawab Ali
AU  - Irfan Mansha
AU  - Safiullah Khan Achakzai
AU  - Mirwais Khan
AU  - Khan Alam
AU  - Bingyin Shi
Y1  - 2021/11/17
PY  - 2021
N1  - https://doi.org/10.11648/j.ajlm.20210606.11
DO  - 10.11648/j.ajlm.20210606.11
T2  - American Journal of Laboratory Medicine
JF  - American Journal of Laboratory Medicine
JO  - American Journal of Laboratory Medicine
SP  - 83
EP  - 87
PB  - Science Publishing Group
SN  - 2575-386X
UR  - https://doi.org/10.11648/j.ajlm.20210606.11
AB  - Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation: A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion: lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.
VL  - 6
IS  - 6
ER  -

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Author Information

Hamad Haider Khan

Department of Endocrinology, First Affiliated Hospital of Xian Jiaotong University, Xi’an, China
Hameed Ullah

Department of Cardiology, First Affiliated Hospital, Xian Jiaotong University, Xi’an, China
Hui Guo

Department of Endocrinology, First Affiliated Hospital of Xian Jiaotong University, Xi’an, China
Siraj Ulhaq Khan

Department of Endocrinology, First Affiliated Hospital of Xian Jiaotong University, Xi’an, China
Shida Hussain

Department of Medicine, Northwest General Hospital, Peshawar, Pakistan
Zahid Nadeem

Department of Radiology, Second Affiliated Hospital, Xian Jiaotong University, Xi’an, China
Faiz Ullah Khan

Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
Ayesha Jamil

Internal Medicine, Wah Medical Hospital, Wah Cantonment, Pakistan
Nawab Ali

Internal Medicine, Saidu Hospital, Swat, Pakistan
Irfan Mansha

Department of Endocrinology, First Affiliated Hospital of Xian Jiaotong University, Xi’an, China
Safiullah Khan Achakzai

Center for Advanced Studies in Vaccinology and Biotechnology, Balochistan Quetta, Pakistan
Mirwais Khan

Balochistan Institute of Nephrology and Urology Quetta, Quetta, Pakistan
Khan Alam

Internal Medicine, Westside Regional Medical Center, Westside Regional, USA
Bingyin Shi

Department of Endocrinology, First Affiliated Hospital of Xian Jiaotong University, Xi’an, China

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Plain Text BibTeX RIS

APA Style

Hamad Haider Khan, Hameed Ullah, Hui Guo, Siraj Ulhaq Khan, Shida Hussain, et al. (2021). Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy. American Journal of Laboratory Medicine, 6(6), 83-87. https://doi.org/10.11648/j.ajlm.20210606.11

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ACS Style

Hamad Haider Khan; Hameed Ullah; Hui Guo; Siraj Ulhaq Khan; Shida Hussain, et al. Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy. Am. J. Lab. Med. 2021, 6(6), 83-87. doi: 10.11648/j.ajlm.20210606.11

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AMA Style

Hamad Haider Khan, Hameed Ullah, Hui Guo, Siraj Ulhaq Khan, Shida Hussain, et al. Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy. Am J Lab Med. 2021;6(6):83-87. doi: 10.11648/j.ajlm.20210606.11

Copy | Download

@article{10.11648/j.ajlm.20210606.11,
  author = {Hamad Haider Khan and Hameed Ullah and Hui Guo and Siraj Ulhaq Khan and Shida Hussain and Zahid Nadeem and Faiz Ullah Khan and Ayesha Jamil and Nawab Ali and Irfan Mansha and Safiullah Khan Achakzai and Mirwais Khan and Khan Alam and Bingyin Shi},
  title = {Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy},
  journal = {American Journal of Laboratory Medicine},
  volume = {6},
  number = {6},
  pages = {83-87},
  doi = {10.11648/j.ajlm.20210606.11},
  url = {https://doi.org/10.11648/j.ajlm.20210606.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20210606.11},
  abstract = {Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation: A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion: lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy
AU  - Hamad Haider Khan
AU  - Hameed Ullah
AU  - Hui Guo
AU  - Siraj Ulhaq Khan
AU  - Shida Hussain
AU  - Zahid Nadeem
AU  - Faiz Ullah Khan
AU  - Ayesha Jamil
AU  - Nawab Ali
AU  - Irfan Mansha
AU  - Safiullah Khan Achakzai
AU  - Mirwais Khan
AU  - Khan Alam
AU  - Bingyin Shi
Y1  - 2021/11/17
PY  - 2021
N1  - https://doi.org/10.11648/j.ajlm.20210606.11
DO  - 10.11648/j.ajlm.20210606.11
T2  - American Journal of Laboratory Medicine
JF  - American Journal of Laboratory Medicine
JO  - American Journal of Laboratory Medicine
SP  - 83
EP  - 87
PB  - Science Publishing Group
SN  - 2575-386X
UR  - https://doi.org/10.11648/j.ajlm.20210606.11
AB  - Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation: A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion: lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.
VL  - 6
IS  - 6
ER  -

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