Autoimmune hypophysitis? A presumptive diagnosis arising from incidentally discovered central hypothyroidism

Inflammatory lesions of the hypothalamo-pituitary axis are rare, accounting for 0.38% of pituitary abnormalities. Among these, autoimmune hypophysitis is a key etiology to recognize. It requires early initiation of hormone replacement therapy and corticosteroids to preserve vital prognosis and reverse neuro-ophthalmological and/or pituitary symptoms. We report the case of a chronic hemodialysis patient, candidate for a kidney transplant, in whom the pre-transplant biological assessment revealed central hypothyroidism, a sign that led us towards the presumptive diagnosis of primary hypophysitis. Through this case, we aim to highlight the diagnostic challenges posed by this condition due to its nonspecific clinical and radiological signs, and the risk of misdiagnosis due to biased clinical management.