Primary Granulomatous Hypophysitis Presenting with Panhypopituitarism and Central Diabetes Insipidus

Primary granulomatous hypophysitis is a rare inflammatory disorder of the pituitary gland and patients commonly present with symptoms of sellar compression and hypopituitarism.A 48-year-old woman was admitted due to headache and fatigue.Magnetic resonance imaging showed a 21 × 18 × 13-mm round sellar mass with a thickened pituitary stalk.The endocrinological examination revealed panhypopituitarism and diabetes insipidus.Suspecting hypophysitis, the patient was given steroid and hormone replacement therapy.Six months later, she continued to complain of severe headaches and nausea.Computed tomography showed no significant change in the sellar mass.Subsequently, transsphenoidal surgery was performed.The pathological examination revealed granulomatous changes with multinucleated giant cells and primary granulomatous hypophysitis was diagnosed.Her headache resolved, but the pituitary functions did not improve.This is the first reported case in Korea of primary granulomatous hypophysitis with dysfunction of anterior and posterior pituitary gland, including the stalk, without optic chiasm compression.(Korean