Sarcoïdose hypophysaire mimant un adénome hypophysaire: à propos d'un cas et revue de la littérature

Isolated involvement of the hypothalamic-pituitary axis in patients with sarcoidosis is rare. Only a few cases have been reported in the literature. We report the clinical case of a 50-years old female patient who had undergone total thyroidectomy followed by replacement therapy because of goitre 4 years before. She complained of chronic headaches persisting for 6 months and resistant to all appropriate therapies, with concomitant decrease in visual acuity. Clinical examination showed optochiasmatic syndrome with extensive visual field defect and common oculomotor nerve palsy in the right eye with ptosis. Brain MRI objectified pathological process to the sellar region with heterogeneous tissue signal intensity extending to the pituitary stalk with thickening in the latter. Preoperative hormonal assessment showed mild thyrotropic deficiency. The patient underwent wide transnasal endoscopic transsphenoidal resection of fibrous and little bleeding tumor. Postoperative outcome was marked by the occurrence of diabetes insipidus and CSF fistula two days after surgery. Patient’s outcome was good under medical treatment with spinal drainage. Thoracoabdominal CT scan and cardiac ultrasound were performed which showed no other site of occurrence of sarcoidosis. Dose of converting enzyme was normal. The patient received corticosteroid therapy for the treatment of systemic disease. Neurosarcoidosis is a criterion of poor prognosis in a patient with sarcoidosis. Hypothalamopituitary involvement is rare resulting in complications which are more frequent than those of other neurological and systemic disorders. This requires multidisciplinary long term management.