Physiological pituitary hyperplasia misinterpreted and treated as lymphocytic hypophysitis

Description 

A 19-year-old nulliparous eumenorrhoeic woman diagnosed with bilateral serous retinal detachment was referred for incidentally detected enlarged pituitary gland, seen on MRI of orbit. A focused MRI documented diffuse, symmetric enlargement of the pituitary gland having a convex superior surface abutting the optic chiasm (11.4 mm in antero-posterior x 16.9 mm in transverse x 9.3 mm in height) with marked homogeneous gadolinium enhancement with a thickened, non-tapering stalk (3.5 mm at infundibulum) and a conspicuous eutopic posterior pituitary bright spot (figure 1). A comprehensive work-up remained unremarkable (table 1). In view of symmetric, enlarged pituitary demonstrating intense homogeneous contrast enhancement and a thickened (>2–3 mm thickness is considered pathological), non-tapering pituitary stalk in this non-pregnant individual, a diagnosis of lymphocytic hypophysitis (LH) was considered, after ruling out the other possible differential diagnosis. Pulse therapy with intravenous methylprednisolone was initiated followed by maintenance therapy with daily prednisolone gradually tapered over 12 weeks....

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