Lymphocytic hypophysitis is a rare autoimmune condition affecting the pituitary gland that commonly occurs during pregnancy and the postpartum period.
A 21-year-old woman presented 6 days postpartum with progressive headache, blurred vision, and left hemianopia. Imaging demonstrated a sellar lesion with mass effect on the optic chiasm. Differential diagnosis included lymphocytic hypophysitis and pituitary adenoma. She was treated with steroids without resolution of symptoms. Surgical alternatives of observation, medical management, and radiosurgery were discussed with the patient. Ultimately, as the patient had an unclear diagnosis and acute vision loss, surgery was chosen to obtain diagnosis and allow decompression of the sella and the optic apparatus. Consent was obtained, and the patient was taken for an endoscopic endonasal transsphenoidal approach for sellar decompression and biopsy.
Following decompression and biopsy, pathology confirmed lymphocytic hypophysitis. The patient’s visual acuity was 20/20 postoperatively and returned to full baseline at 2 months follow-up. MRI obtained at 10 months follow-up demonstrated resolution of the suprasellar mass.
We present a video case report of the endoscopic endonasal approach for sellar decompression and biopsy for lymphocytic hypophysitis. While medical management remains the mainstay of treatment for lymphocytic hypophysitis, cases like ours demonstrate that neurosurgical intervention is safe, effective, and should be considered for patients with symptomatic mass effect.
Source of work or study: The work described was performed during routine multidisciplinary clinical care in an academic medical center. Patient consent for this project was obtained.
No competing financial interests exist.
Runtime of video: 5 mins, 30 secs.