Department of Laboratory Medicine, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada.
Endocr Pathol. 2011 Mar;22(1):6-9. doi: 10.1007/s12022-011-9148-9.
We report the case of a 45-year-old Colombian female with a 3-month history of headache, anorexia, fatigue, and diplopia in addition to left facial nerve palsy 2 weeks prior to presentation. On examination, visual fields and fundi were normal, but left abducens and facial nerve palsies were noted. An MRI scan disclosed a sellar mass with suprasellar but neither parasellar nor retrosellar extension. The mass was interpreted as a pituitary tumor and resected via the transsphenoidal approach. Histologic examination revealed necrotizing granulomas in a background of normal pituitary gland tissue. The differential diagnosis includes tuberculosis, sarcoidosis, fungal infection, syphilis, granulomatous autoimmune hypophysitis, Langerhans cell histiocytosis, and Erdheim-Chester disease. Staining for tubercle bacilli (acid fast and fite) as well as for fungi (GMS) was negative and PCR for mycobacteria showed the same result. Postoperative empiric treatment with antituberculous medication resulted in resolution of the cranial nerve palsies within a 1 month. The diagnosis of inflammatory/infectious granulomatous hypophysitis can be difficult to diagnose preoperatively and occasionally even postoperatively. A high index of suspicion should be maintained especially in those patients with a history of a systemic granulomatous disease or in regions endemic in granulomatous infectious diseases.
我们报告了一例 45 岁的哥伦比亚女性病例，她在出现头痛、食欲不振、疲劳和复视的症状 3 个月后，在就诊前 2 周出现左侧面神经瘫痪。体格检查发现视野和眼底正常，但左侧展神经和面神经瘫痪。MRI 扫描显示蝶鞍内有肿块，鞍上但无鞍旁或鞍后扩展。该肿块被认为是垂体瘤，并通过经蝶窦入路切除。组织学检查显示正常垂体组织背景下存在坏死性肉芽肿。鉴别诊断包括结核、结节病、真菌感染、梅毒、肉芽肿性自身免疫性垂体炎、朗格汉斯细胞组织细胞增生症和 Erdheim-Chester 病。抗酸杆菌（抗酸和 fite）和真菌（GMS）染色均为阴性，分枝杆菌 PCR 结果相同。术后经验性抗结核治疗在 1 个月内使颅神经瘫痪得到缓解。术前炎症/感染性肉芽肿性垂体炎的诊断较为困难，有时甚至术后也难以诊断。特别是对于有全身肉芽肿性疾病病史或在肉芽肿性传染病流行地区的患者，应保持高度怀疑。
