A 32-year-old pregnant woman presented to our hospital at 32 weeks' gestation with progressive headache and visual disturbance. Head MRI revealed a homogeneously well Gd-enhanced parasellar lesion with optic chiasma compression. After delivery by cesarean section at 35 weeks' gestation, the lesion was biopsied by endoscopic endonasal approach and diagnosed as lymphocytic hypophysitis. External decompression with resection of the tuberculum sellar was also added for rapid decompression of the optic nerve to preserve visual function. The postoperative course was uneventful and visual function improved immediately after surgery.
Lymphocytic hypophysitis is rare and difficult to diagnose, especially during pregnancy. There is still no consensus on the treatment strategy. Although drug therapy is the most common treatment, surgical treatment may be considered in a case with drug resistance or worsening of neurological symptoms. In addition to biopsy, surgical treatment may include decompression of the optic nerve with removal of the lesion, although pituitary function cannot be preserved.
In the present case, the neurological symptoms improved immediately after endoscopic endonasal external decompression, which suggested that this novel procedure may be one of the treatment options for lymphocytic hypophysitis to preserve both visual and pituitary function, although careful consideration of the indications for this procedure is mandatory in each case.
