Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.
Adult ; Biopsy ; Female ; Giant Cells/pathology ; Granuloma/complications/*diagnosis/therapy ; Headache/etiology ; Hemianopsia/etiology ; Humans ; Hyperprolactinemia/etiology ; Hypopituitarism/etiology ; Inflammation/complications/*diagnosis/therapy ; Magnetic Resonance Imaging ; Optic Chiasm/pathology ; Pituitary Diseases/complications/*diagnosis/therapy ; Pituitary Function Tests ; Pituitary Gland/*pathology/surgery ; Predictive Value of Tests ; Severity of Illness Index ; Treatment Outcome

We report a case of pituitary apoplexy resulting in right internal carotid artery occlusion accompanied by hemiplegia and lethargy. A 43-yr-old man presented with a sudden onset of severe headache, visual disturbance and left hemiplegia. Investigations revealed a nodular mass, located in the sella and suprasellar portion and accompanied by compression of the optic chiasm. The mass compressed the bilateral cavernous sinuses, resulting in the obliteration of the cavernous portion of the right internal carotid artery. A border zone infarct in the right fronto-parietal region was found. Transsphenoidal tumor decompression following conservative therapy with fluid replacement and steroids was performed. Pathological examination revealed an almost completely infarcted pituitary adenoma. The patient's vision improved immediately after the decompression, and the motor weakness improved to grade IV+ within six months after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. However, clinicians should be aware of the possibility and the appropriate management of such an occurrence.
Adult ; Carotid Artery Diseases/*diagnosis/etiology/therapy ; *Carotid Artery, Internal/pathology/surgery ; Diagnosis, Differential ; Embolization, Therapeutic ; Humans ; Magnetic Resonance Angiography ; Male ; Pituitary Apoplexy/complications/*diagnosis ; Tomography, X-Ray Computed