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A Granulomatous Hypophysitis "Consequent" to a Silent ACTH Cell Adenoma: A Case Report

Elia Guadagno, Mariarosaria Cervasio, Alberto Di Somma, Luigi Maria Cavallo, Marialaura Del Basso De Caro

Herein is described a rare association of granulomatous hypophysitis and a silent corticotroph macroadenoma, observed in a 50- year-old male who came to the attention of the clinicians with a history of frontal headache.
Silent adenomas account for about one quarter of the pituitary adenomas and are characterized by the lack of a characteristic clinical syndrome or serum hormone marker. A granulomatous pituitary inflammatory reaction can be caused by systemic tuberculosis, syphilis, fungal infections or be idiopathic. The coincidence of these two conditions is known in the literature and a few hypotheses have been advanced concerning their relationship. The aim of our report was to scrutinize any possibility of causality that could explain this phenomenon. The ultimate goal was trying to understand a possible prognostic significance of the inflammatory reaction to neoplastic proliferation if there were any.