Lymphocytic hypophysitis with dacryoadenitis in a male patient: non-invasive diagnosis and high-dose methylprednisolone pulse therapy.

OBJECTIVE: Lymphocytic hypophysitis (LH) is a rare autoimmune disorder associated with lymphocytic cell infiltration of the pituitary. It is often detected in patients with other autoimmune systemic diseases such as Hashimoto's thyroiditis, epinephritis, megaloblastic anemia, and Langerhans cell histiocytosis. Pituitary biopsy and invasive histopathological examination provide the most reliable evidence for LH diagnosis. However, because glucocorticoids are extensively used for the treatment of disease, pathological diagnosis is not always necessary. Here, we report a rare case of a male patient (50 y) with LH associated with dacryoadenitis that was successfully treated with high-dose of methylprednisolone.
RESULTS: The patient had a history of swollen lacrimal glands for two years. In addition, magnetic resonance imaging (MRI) showed a markedly thickened infundibular stem and an indiscernible signal in the posterior lobe of the pituitary. Biopsy of the lacrimal glands revealed reactive hyperplasia of the lymphoid tissue. After a high-dose of methylprednisolone pulse treatment (HDMPT), lacrimal gland swelling and infundibular stem thickness were reduced, and adenopituitary function improved within a short time period.
CONCLUSIONS: Although association of LH with dacryoadenitis is a rare, it can be effectively managed with HDMPT. In addition, response to HDMPT can avoid the more invasive diagnostic procedures, including surgical intervention and pituitary biopsies.