Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand.
Pituitary. 2009;12(4):375-9. doi: 10.1007/s11102-008-0119-1.
Lymphocytic hypophysitis (LH) is a rare chronic inflammatory disorder characterized by lymphocytic infiltration of the pituitary gland commonly affecting women during pregnancy or post-partum period. The pathogenesis remains uncertain, however an autoimmune process is frequently implicated. There is limited data on the occurrence of LH outside the setting of autoimmunity.
We describe a 37-year-old man presenting with diarrhoea, nausea, weight loss, low-grade fever, headache and cerebrospinal fluid analysis consistent with aseptic meningitis. Magnetic resonance imaging (MRI) demonstrated a homogenously enlarged pituitary gland with biochemical testing revealing partial hypopituitarism with adenocorticotrophic hormone and gonadotrophin deficiency. Notably, his free thyroid hormone levels were elevated with a suppressed thyroid-stimulating hormone and a suppressed thyroid technetium scan consistent with thyroiditis. Tissue antibodies including thyroid antibodies were negative. Following introduction of hydrocortisone, he developed transient diabetes insipidus which spontaneously resolved after 4 months. Thyrotoxicosis resolved after 5 weeks and thyroxine was commenced as he developed secondary hypothyroidism. Repeat MRI 3 months later showed a reduction in the size of the pituitary gland which by 6 months had returned to normal size. He remains well on hydrocortisone, thyroxine and testosterone replacement.
Based on clinical and radiological grounds, the diagnosis was consistent with lymphocytic hypophysitis associated with subacute thyroiditis. This is only the second report of this combination in the absence of autoimmunity and the first report of LH and thyroiditis with associated aseptic meningitis in the absence of tissue autoantibodies. We propose a possible viral illness as the unifying aetiological cause.
淋巴细胞性垂体炎（LH）是一种罕见的慢性炎症性疾病，其特征为淋巴细胞浸润垂体，常影响妊娠或产后期的女性。其发病机制尚不清楚，但常涉及自身免疫过程。关于自身免疫以外情况下 LH 的发生，数据有限。
我们描述了一名 37 岁男性，表现为腹泻、恶心、体重减轻、低热、头痛和脑脊液分析符合无菌性脑膜炎。磁共振成像（MRI）显示垂体均匀增大，生化检测显示部分垂体功能减退，促肾上腺皮质激素和促性腺激素缺乏。值得注意的是，他的游离甲状腺激素水平升高，促甲状腺激素抑制，甲状腺锝扫描抑制，符合甲状腺炎。组织抗体包括甲状腺抗体均为阴性。在引入氢化可的松后，他出现短暂性尿崩症，4 个月后自行缓解。5 周后甲状腺毒症缓解，由于出现继发性甲状腺功能减退，开始给予甲状腺素。3 个月后重复 MRI 显示垂体缩小，6 个月后恢复正常大小。他仍在接受氢化可的松、甲状腺素和睾酮替代治疗，病情良好。
根据临床和影像学依据，诊断为与亚急性甲状腺炎相关的淋巴细胞性垂体炎。这是在没有自身免疫的情况下该组合的第二例报告，也是在没有组织自身抗体的情况下 LH 和甲状腺炎伴发无菌性脑膜炎的首例报告。我们提出一种可能的病毒感染作为统一的病因。
