Pituitary Xanthogranuloma Causing Sellar Mass in 2 Children With Hypopituitarism and Elevated Inflammatory Markers

Pituitary xanthogranulomas represent a rare group of inflammatory pituitary masses. The prevalence of these lesions is not clearly defined. These lesions, also known as cholesterol granulomas, are diagnosed on histopathological findings including cholesterol clefts, hemosiderin deposits, foamy macrophages, and necrosis. They often present with pituitary hormone deficiencies and have a low recurrence rate following gross total resection. We describe 2 patients presenting with headaches, polyuria, polydipsia, and elevated erythrocyte sedimentation rate. One patient had a history of Rathke cleft cyst (RCC). Magnetic resonance imaging identified sellar masses, and they were subsequently diagnosed with varying degrees of pituitary hormone deficiencies preoperatively. They underwent transsphenoidal mass resection with pathology showing xanthogranuloma. Postoperatively they have panhypopituitarism including arginine vasopressin deficiency and no recurrence of the lesion. Inflammatory causes of pituitary lesions should remain on the differential, especially in patients with a history of RCC. More research is needed to identify the prevalence of xanthogranulomatous pituitary lesions and better understand the pathophysiology of their formation. The finding of elevated inflammatory markers, not usually seen in other pituitary masses or previously documented in the literature in cases of xanthogranulomatous pituitary lesions, could reflect a clinical clue when evaluating patients with pituitary lesions.