Hypophysitis: a new member of the family

Hypophysitis was an unusual complication in the late pregnancy and postpartum. Now, other clinicians and mainly oncologist have to think on this important problem because the new immunological treatments are associated with a low percentage (1%)  with this syndrome and the recognition could be difficult, but there is a key symptom…

CLINICAL CASE:  A patient with disseminated melanoma started with fatigue and a strong headache after the second dose of an immunological treatment. No visual disturbances or other signs were present  in the physical examination.

PHYSICIAN REASONING:  The first possibility for the oncologist was to think about CNS metastases, but the CAT scan was normal. Then the doctor asked for a MNR thinking in two entities: cavernous sinus thrombosis and hypophysitis. The patient started treatment with Dexametasone with a mild improvement in the headache.

Here we show the MNR after a week with Dexamethasone. The hypophysis is not clearly increased in size, but the superior edge is irregular. A blood test confirms a central hypothyroidism as a confirmation of a hypophysis failure.