Use of a clinicoradiological score to determine the presurgical diagnosis of autoimmune hypophysitis in a teenage girl

J Neurosurg Pediatr. 2013 Mar;11(3):335-9. doi: 10.3171/2012.11.PEDS12432. Epub 2013 Jan 4.

Abstract

The distinction between autoimmune hypophysitis and other non-hormone secreting pituitary masses is often difficult to determine with certainty without pituitary biopsy and pathological examination. To aid in this distinction, the authors recently published a clinicoradiological scoring system, which they used in the case of a 15-year-old girl presented here. The patient presented with headache, visual field defects, polydipsia, and polyuria, and she was found to have secondary hypogonadism and hypoadrenalism. Magnetic resonance imaging showed a pituitary mass of approximately 2 cm in diameter. Application of the clinicoradiological parameters gave a score of -6, which favored a diagnosis of hypophysitis over that of adenoma. The presence of pituitary autoantibodies substantiated the diagnosis of hypophysitis. The patient was treated conservatively with high-dose prednisolone, and her symptoms improved markedly. This case illustrates the utility of using a clinicoradiological score when autoimmune hypophysitis is suspected since it can identify patients who can be treated without the need for pituitary surgery.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / therapeutic use
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / diagnostic imaging
  • Autoimmune Diseases / therapy
  • Female
  • Headache / etiology
  • Humans
  • Hypopituitarism / diagnosis*
  • Hypopituitarism / diagnostic imaging
  • Hypopituitarism / therapy
  • Magnetic Resonance Imaging
  • Pituitary Gland / pathology
  • Pituitary Hormones / blood
  • Prednisolone / therapeutic use
  • Radiography
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Pituitary Hormones
  • Prednisolone