Case Report Postpartum Granulomatous Hypophysitis: A Case Study, Review of the Literature, and Discussion of Pathogenesis Upasana Joneja, 1 D. Craig Hooper, 2,3 James J. Evans, 3 and Mark T. Curtis 1 1 Department of Pathology, Cell Biology and Anatomy, Tomas Jeferson University Hospitals, Philadelphia, PA, USA 2 Department of Cancer Biology, Tomas Jeferson University Hospitals, Philadelphia, PA, USA 3 Department of Neurosurgery, Tomas Jeferson University Hospitals, Philadelphia, PA, USA Correspondence should be addressed to Mark T. Curtis; mark.curtis@jeferson.edu Received 24 May 2016; Accepted 31 July 2016 Academic Editor: Piero Tosi Copyright © 2016 Upasana Joneja et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hypophysitis is a rare infammatory condition of the pituitary gland that has three main histologic subtypes: lymphocytic hypophysitis (LH), granulomatous hypophysitis (GH), and xanthomatous hypophysitis (XH). Among these, LH is the most common and is strongly associated with the postpartum state, while XH is the least common. Many hypophysitis cases have been reported in the literature but only a few cases of postpartum GH have been discussed. Here, we describe a case of GH in a 24-year-old female presenting eleven days postpartum. We also review the current literature on postpartum GH and discuss the possible alterations in the immune environment during and afer pregnancy that could explain this phenomenon. With more cases of GH being reported, the commonalities of female predominance, postpartum time of presentation, and occasional spontaneous resolution between LH and GH lend support to the theory that these two diseases likely represent spectrums of a single immunologic disorder. 1. Introduction Hypophysitis, infammation of the pituitary gland, commonly presents as a sellar mass on radiologic imaging and is ofen mistaken for a pituitary adenoma [1, 2]. It is rare and accounts for less than 1% of all sellar lesions identifed on imaging [2]. Te three main histologic subtypes of hypophysitis are lymphocytic hypophysitis (LH), granulomatous hypophysitis (GH), and xanthomatous hypophysitis (XH). Xanthogranu- lomatous and necrotizing hypophysitis are also considered subtypes of hypophysitis, but they are infrequently reported [3]. GH can occur as a primary process or as a consequence of preexisting systemic disease. Eighty-fve cases of GH have been reported in the literature with 5 cases presenting during the postpartum state. Te current report describes a case of postpartum GH and addresses the possibility that alterations in the immune environment associated with the antepartum and postpartum periods play a role in the development of GH. 2. Case Presentation A 24-year-old African American female G5P0023 presented to the emergency room with complaints of progressive, throbbing headaches and nausea for nine days. Eleven days earlier, she delivered a healthy full term baby via uncompli- cated vaginal delivery. Te patient also complained of blurry vision, fevers, lethargy, and photophobia. She denied any past medical history of migraines, seizures, eclampsia, or pree- clampsia during pregnancy. Te patient was febrile to 101.7 ∘ F and normotensive. An MRI revealed a 2.4 × 2.2 × 1.5 cm homogeneously enhancing sellar mass with a dark band sur- rounding the gland with infltration into the base of the brain. Chiasmal compression, edema of the optic tracts, and mild dural enhancement anterior to the mass were noted. Pituitary stalk was difcult to visualize and its involvement could not be assessed. Te MRI displayed features suggestive of an infammatory process; however, a pituitary macroadenoma could not be completely ruled out (Figures 1(a) and 1(b)). In Hindawi Publishing Corporation Case Reports in Pathology Volume 2016, Article ID 7510323, 5 pages http://dx.doi.org/10.1155/2016/7510323