Virginia Via Research Day Book 2026

Medical Student Research Case Reports

07 LYMPHOCYTIC HYPOPHYSITIS IN A MALE CHILD: A RARE PEDIATRIC CASE REPORT

Mahya Abedi-Jafari, OMS-III, Narmeen Rasul, OMS-III, Aliza Ishrat, OMS-III, Oscar Sugastti, M.D. Corresponding author:mabedijafari@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

fluids and stress dose hydrocortisone. Laboratory testing confirmed panhypopituitarism and central DI. MRI revealed pituitary stalk thickening, a heterogeneously enhancing sellar lesion, and absence of the posterior pituitary bright spot. These findings raised concern for an infiltrative or neoplastic process such as germinoma. A small incidental left frontal subcortical lesion was also identified. He underwent multidisciplinary evaluation, lumbar puncture, and repeat imaging. Due to ongoing concern for germinoma, he ultimately underwent an endonasal endoscopic transsphenoidal biopsy, which revealed lymphocytic hypophysitis. He was managed with physiologic hydrocortisone, desmopressin, and levothyroxine. His headaches and fatigue resolved, DI stabilized on DDAVP, and he returned to normal daily functioning. Over more than two years of follow-up, MRI studies showed stable findings without progression. He continued to require hormone replacement for central adrenal insufficiency, central hypothyroidism, and central DI, but remained clinically well.

Background: Lymphocytic hypophysitis (LH) is an autoimmune inflammatory disorder of the pituitary gland that typically occurs in adult women, usually during the peripartum period. Pediatric cases are rare, and the condition is especially uncommon in adolescent males. In a comprehensive literature search, we have found only 4 reported cases in pediatric males. LH may present with anterior and posterior pituitary hormone deficiencies, and central diabetes insipidus (DI) is a frequent early finding. Radiographic features can resemble germinoma or other infiltrative lesions, which makes diagnosis challenging. Despite its rarity in this age group, LH should be considered in adolescents who present with hypopituitarism and a pituitary stalk lesion. Case Presentation: We report the case of a 16-year-old previously healthy male presenting with two months of worsening headaches, lightheadedness, fatigue, significant polyuria and polydipsia, and unintended weight loss. He was admitted in adrenal crisis and improved after treatment with intravenous

Conclusion: This case expands the limited body of biopsy-confirmed LH in adolescent males and underscores the importance of maintaining a broad differential when evaluating young patients with central DI and pituitary hormone deficiencies. Although rare in this population, LH should be included among potential etiologies of sellar and stalk-based lesions. Early recognition and appropriate hormone replacement were essential for this patient's recovery, and his long-term course reflects the persistent pituitary deficits that are common in LH. This case contributes meaningful insight into an uncommon presentation and highlights the value of considering LH even when patient demographics fall outside the typical profile.

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44 Edward Via College of Osteopathic Medicine (VCOM)