Lymphocytic hypophysitis presenting as pituitary apoplexy in a male.

CMYK363 with bromocriptine and prepared for surgery. A right frontal craniotomy using subfrontal approach was performed. Upon incising the diaphragma sellae 5–7 ml of necrotic material was excised. Postoperatively, the patient developed frank diabetes insipidus that needed aqueous vasopressin treatment. His visual acuity did not improve. Haematoxylin and eosin-stained sections from the biopsy showed complete effacement of the pituitary structure by a dense lymphoplasmacytic infiltrate and foci of neutrophilic infiltration, necrosis, and fibrosis [Figure 3]. No tumor could be identified. Stains for bacteria, fungi, Acid Fast Bacilli and spirochaetes were negative. Immunohistochemistry revealed a polyclonal lymphoid population with a mixture of T and B cells. A diagnosis of lymphocytic hypophysitis was considered. The patient was discharged on a maintenance dose of steroids and is currently on regular follow up. Lymphocytic hypophysitis closely mimics a pituitary adenoma both clinically and radiologically. MR features suggestive of an inflammatory pituitary process include loss of Figure 2: T2W sagittal MR image showing a sellar mass with thickened stalk and suprasellar extension