Padilla-Martínez Juan José, González-Cornejo Salvador, Alvarez-Palazuelos Lucía Elizabeth, Villagómez-Méndez Jesús Alejandro, Chiquete Erwin, Domínguez-Rosales José Alfredo, Espejo-Plascencia Ismael, González-Díaz Esteban, Torres-Baranda José Rodrigo, Ruiz-Sandoval José Luis
Department of Neurology and Neurosurgery;
Neurol Int. 2009 Nov 16;1(1):e18. doi: 10.4081/ni.2009.e18.
Lymphocytic or granulomatous hypophysitis is a rare entity with a difficult diagnosis. Our objective was to report a patient with non-tuberculous granulomatous hypophysitis. An HIV-negative 45-year old man with confusional state, subacute ophthalmoplegia, and clinical and laboratory findings of panhypopituitarism was seen in the emergency unit. A cranial MRI showed a sellar mass suggestive of hypophysitis. After an unsuccessful attempt with steroids and antituberculous drugs the patient died. Post-mortem histopathology revealed granulomatous lesions and restriction fragment length polymorphism analysis confirmed the presence of Mycobacterium gordonae's DNA. In conclusion, we should consider granulomatous hypophysitis in the differential diagnosis of non-secreting hypophyseal tumors. The etiology of a pituitary granuloma by a non-tuberculous mycobacteria is best reached by histopathological techniques and molecular assays. The optimal therapy is yet to be established.
淋巴细胞性或肉芽肿性垂体炎是一种罕见且诊断困难的疾病。我们的目的是报告一例非结核性肉芽肿性垂体炎患者。一名45岁HIV阴性男性因意识模糊、亚急性眼肌麻痹以及全垂体功能减退的临床和实验室检查结果而被送至急诊科。头颅磁共振成像显示鞍区有一肿块，提示垂体炎。在使用类固醇和抗结核药物治疗失败后，患者死亡。尸检组织病理学显示肉芽肿性病变，限制性片段长度多态性分析证实存在戈登分枝杆菌DNA。总之，在非分泌性垂体肿瘤的鉴别诊断中，我们应考虑肉芽肿性垂体炎。通过组织病理学技术和分子检测最能明确非结核分枝杆菌引起垂体肉芽肿的病因。最佳治疗方案尚未确立。
