Corticosteroid treatment buys time in case of a newly diagnosed hypophysitis with visual deterioration

Hypophysitis is an important differential diagnosis for a pituitary mass, especially in young women at the end of or shortly after pregnancy. It commonly results in hypopituitarism and can be differentiated from adenoma on MRI. Typical MRI characteristics of hypophysitis are symmetry, loss of posterior bright spot, intense and homogeneous gadolinium enhancement, a thickened pituitary stalk and intact sellar floor. Treatment of choice in the acute phase of a hypophysitis is corticosteroids. Adequate corticosteroid treatment may effectively buy time and avoid unnecessary surgical treatment and is related to further decrease of pituitary function, even in progressive cases of deterioration due to compression of the chiasm. Strict monitoring of the vision and a control MRI is obligatory to evaluate the treatment after 48–36 h. Tissue diagnosis is mandatory when there are multiple relapses. We present a case of progressive visual deterioration in hypophysitis, successfully treated with high-pulse dose prednisolone.