Apoplectic lymphocytic hypophysitis

headache, vision loss, and ophthalmoplegia from pituitary hemorrhage or infarction characterize pituitary apoplexy,1,3,6–8 and MR imaging of the brain often demonstrates a pituitary mass with heterogeneous signal due to the presence of blood.7 Apoplexy typically occurs in a previously unrecognized pituitary adenoma, but it can also occur when the pituitary gland is normal. Various precipitating factors have been reported including medication, radiotherapy, surgery, anticoagulation therapy, head trauma, and pregnancy.1,6 Lymphocytic hypophysitis is a rare inflammatory disorder of the pituitary gland, occurring more often in women. The disorder often becomes manifest late in pregnancy or the postpartum period.2,4,5,9,10 It can present as a pituitary mass causing hypopituitarism and visual disturbances. The neuroimaging characteristics may be identical to those of a pituitary adenoma, and histological examination is generally required to differentiate the two.4,5 Lymphocytes and plasma cells with varying numbers of eosinophils, neutrophils, and macrophages are observed with light microscopy. There may be destruction of the pituitary parenchyma, and the results of immunohistochemical analysis may be positive for T and/or B cells.9 We present the case of a pregnant woman with pituitary apoplexy in the setting of lymphocytic hypophysitis.