Autoimmune hypophysitis: a case of follow-up during the COVID-19 pandemic period

Hypophysitis is a rare inflammatory disorder that affects the pituitary gland and infundibulum, stems from autoimmune, infiltrative, infectious, or unknown causes. Its clinical diagnosis can be challenging because several pituitary lesions, including adenomas and metastases, may clinically present with similar characteristics. Magnetic resonance imaging is crucial for diagnosing suspected cases of hypophysitis and categorizing them as adenohypophysitis (anterior pituitary gland involvement) or infundibulo-neurohypophysitis (pituitary stalk and posterior pituitary involvement). Hypophysitis can be categorized as primary (autoimmune) or secondary due to local lesions (e.g., granulomas, cysts, adenomas) or systemic diseases (e.g., sarcoidosis, Wegener’s granulomatosis). Different factors may have impact on clinical course of hypophysitis. Among them background treatment. These cases have not been sufficiently studied and are practically not presented in publications.

A 37-year-old female with a history of hyperprolactinemia was being treated symptomatically with cabergoline. At first magnetic resonance imaging heterogeneity of the hypophysis was revealed. In September 2021 the follow-up magnetic resonance imaging revealed an increase in the size and heterogeneity of the pituitary gland. In December 2021, the patient developed severe COVID-19-associated pneumonia and was treated with corticosteroids and oxygen support. In May 2022 magnetic resonance imaging revealed a marked increase in the size and heterogeneity of the pituitary gland. Significant clinical and radiological improvement were stated after adding prednisone (10 mg in the morning and 5 mg in the evening) to her treatment.

The patient was followed-up during the COVID-19 pandemic. The management and imaging studies of such patients may be tricky due to the effects related to COVID-19 and its treatment.

During monitoring of hypophysitis, physicians should consider the impact of COVID-19 treatment, particularly corticosteroid therapy, when evaluating the radiological changes.