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title: "Lymphocytic Hypophysitis"
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docid: "f30774c3-cbd0-4ab3-b3d1-e0574106db1f"
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breadcrumbs:
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- "Brain"
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- "Diagnosis"
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- "Anatomy-Based Diagnoses"
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- "Sella and Pituitary"
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- "Miscellaneous"
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- "Lymphocytic Hypophysitis"
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---
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# KEY FACTS
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- ## Terminology
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- Lymphocytic hypophysitis (LH)
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- Synonyms: Adenohypophysitis, primary hypophysitis, stalkitis
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- Idiopathic inflammation of pituitary gland &/or stalk
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- ## Imaging
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- Thick stalk (> 2 mm + loss of normal "top to bottom" tapering)
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- ± enlarged pituitary gland
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- 75% show loss of posterior pituitary "bright spot"
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- Enhances intensely, uniformly
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- May have adjacent dural or sphenoid sinus mucosal thickening
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- ## Top Differential Diagnoses
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- Macroadenoma
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- Pituitary hyperplasia
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- Adolescent pituitary gland
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- Granulomatous disease
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- Ectopic posterior pituitary gland
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- ## Clinical Issues
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- Autoimmune, inflammatory disorder; other etiologies: Granulomatous disease, IgG4 disease or drug related
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- Peripartum woman with headache, multiple endocrine deficiencies
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- Middle-aged man with diabetes insipidus (lymphocytic infundibuloneurohypophysitis)
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- Mean in women = 35 years, men = 45 years
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- M:F = 1:8-9
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- Often self-limited
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- Unrecognized, untreated LH can result in death from panhypopituitarism
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- Conservative care (steroids, hormone replacement)
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- ## Diagnostic Checklist
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- LH can mimic pituitary adenoma
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# TERMINOLOGY
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- ## Abbreviations
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- Lymphocytic hypophysitis (LH)
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- ## Synonyms
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- Adenohypophysitis, primary hypophysitis, stalkitis
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- ## Definitions
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- Idiopathic inflammation of pituitary gland or stalk
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# IMAGING
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- ## General Features
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- ### Best diagnostic clue
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- Thick, nontapered stalk, ± pituitary mass
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- ### Location
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- Suprasellar, intrasellar
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- ### Size
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- Usually < 10 mm but may reach 2-3 cm
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- ### Morphology
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- Rounded pituitary gland with infundibulum that appears thickened, nontapering, or bulbous
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- ## MR Findings
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- ### T1WI
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- Thick stalk (> 2 mm + loss of normal tapering)
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- ± enlarged pituitary gland
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- 75% show loss of posterior pituitary "bright spot"
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- ### T2WI
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- Iso-/hypointense
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- ### T1WI C+
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- Enhances intensely, uniformly
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- May see dural or sphenoid sinus mucosal thickening
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- ## Imaging Recommendations
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- ### Best imaging tool
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- MR
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- ### Protocol advice
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- MR: Precontrast thin-section (< 3 mm) sagittal, coronal T1 and T2
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- Coronal dynamic T1 C+ (may show delayed pituitary enhancement)
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# DIFFERENTIAL DIAGNOSIS
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- [Macroadenoma](/document/pituitary-macroadenoma/14ebde13-80bb-4c4e-833c-fcc6c992d47c)
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- Sellar and suprasellar mass
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- Sella turcica enlarged/eroded
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- Diabetes insipidus common in LH, rare with adenoma
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- [Pituitary Hyperplasia](/document/pituitary-hyperplasia/9696bc9e-f00b-4fa7-aa67-f039efd8fbed)
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- Stalk usually normal
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- In young female patients, late pregnancy/peripartum
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- May be seen with hypothyroidism, Addison disease, end-organ failure, neuroendocrine neoplasms
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- ## Adolescent Pituitary
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- Enlarged gland with uniform enhancement
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- ## Granulomatous Disease
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- Sarcoid, Langerhans cell histiocytosis (LCH), granulomatosis with polyangiitis; systemic disease often present
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- ## Pituitary "Dwarf"
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- Stalk may appear short and stubby
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- ## Ectopic Posterior Pituitary
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- Hyperintense focus at tuber cinereum or truncated stalk
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# PATHOLOGY
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- ## General Features
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- ### Etiology
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- Autoimmune, inflammatory disorder
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- Other types of hypophysitis include
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- Granulomatous (sarcoid, LCH, infectious, etc.)
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- IgG4-related hypophysitis
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- Drug-related [cancer immunotherapy (e.g., ipilimumab)]
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- ## Gross Pathologic & Surgical Features
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- Diffusely enlarged stalk/pituitary gland
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- ## Microscopic Features
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- Acute
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- Dense infiltrate of B/T lymphocytes, plasma cells, occasionally eosinophils; ± lymphoid follicles
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- No granulomas, giant cells, or organisms; no neoplasm
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- Chronic may demonstrate extensive fibrosis
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# CLINICAL ISSUES
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- ## Presentation
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- ### Most common signs/symptoms
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- Headache, visual impairment
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- ### Clinical profile
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- Peripartum woman with headache, multiple endocrine deficiencies
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- Middle-aged man with diabetes insipidus (lymphocytic infundibuloneurohypophysitis)
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- ## Demographics
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- ### Age
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- Mean in women = 35 years, men = 45 years
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- ### Sex
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- M:F = 1:8-9
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- ### Epidemiology
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- Rare (1-2% of sellar lesions)
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- ## Natural History & Prognosis
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- Often self-limited
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- Unrecognized, untreated LH can result in death from panhypopituitarism
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- ## Treatment
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- Conservative (steroids, hormone replacement)
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# DIAGNOSTIC CHECKLIST
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- ## Image Interpretation Pearls
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- LH can mimic pituitary adenoma
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1c7008d4-15aa-4440-a8e1-29841f3caa42
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