Rotondaro Julio C, Bettaza Celeste, Clifton Goldney Dolores, Martinez Gabriela, Paz Leonardo, Gazzi Carla, González Abbati Santiago, Tarnogol Mariano, Miguel Silvia, Iungman Ariel
Servicio de Clínica Médica, Instituto de investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina. E-mail:
Servicio de Clínica Médica, Instituto de investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina.
Medicina (B Aires). 2023;83(6):1007-1012.
Hypophysitis is a pathology with low incidence and prevalence. Likewise, deep fungal infections in immunocompetent patients also represent a rare phenomenon. Even rarer is the case described below, where these two mentioned elements are combined, namely: pituitary cryptococcoma or granulomatous hypophysitis caused by said pathogen in a host without altered immune response. After research in PubMed, there are limited cases in the medical literature of granulomatous hypophysitis caused by Cryptococcus spp., which simulated a pituitary macroadenoma by clinical and imaging manifestations. We did not find reports in which there is no evidence of involvement of the meningeal tissue. The fungal etiology is scarcely described in the reference guidelines for hypophysitis and we believe that Cryptococcus spp. it should be taken into account in the differential diagnosis of secondary granulomatous hypophysitis since it is a ubiquitous pathogen and the treatment is substantially different from other entities. It becomes more relevant given the current trend towards the use of high-dose systemic glucocorticoids for the treatment of hypophysitis, which could have generated greater damage if the correct diagnosis had not been made.
垂体炎是一种发病率和患病率较低的病理状况。同样，免疫功能正常的患者发生深部真菌感染也是一种罕见现象。更罕见的是以下所述情况，即上述两种情况同时出现，也就是：在免疫反应未改变的宿主中，由该病原体引起的垂体隐球菌瘤或肉芽肿性垂体炎。在PubMed上检索后发现，医学文献中由隐球菌属引起的肉芽肿性垂体炎病例有限，其临床和影像学表现类似垂体大腺瘤。我们未找到无脑膜组织受累证据的报告。垂体炎的参考指南中很少描述真菌病因，我们认为在继发性肉芽肿性垂体炎的鉴别诊断中应考虑隐球菌属，因为它是一种普遍存在的病原体，其治疗与其他疾病有很大不同。鉴于目前使用大剂量全身性糖皮质激素治疗垂体炎的趋势，如果未做出正确诊断，可能会造成更大损害，这一点就变得更加重要。
