{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:51:58Z","timestamp":1787169118659,"version":"build-2736575974"},"reference-count":11,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Neurosarcoidosis (NS) is a rare form of sarcoidosis, with isolated hypothalamic-pituitary involvement being exceptionally uncommon. We report a 20-year-old woman presenting with polyuria, galactorrhea, amenorrhea, and substantial weight loss. Hormonal evaluation revealed hypopituitarism with arginine-vasopressin deficiency and hyperprolactinemia. Magnetic resonance imaging demonstrated pituitary stalk thickening and suprasellar extension, initially suggestive of hypophysitis. High-dose glucocorticoid therapy resulted in partial regression of the pituitary lesion but persistence of suprasellar involvement, prompting a transcranial stereotactic biopsy. Histopathological analysis confirmed isolated NS with noncaseating granulomas. The patient was treated with rituximab after partial response to glucocorticoids, achieving significant clinical and radiological improvement, although hormonal axis recovery was not observed. Hormone replacement therapy remains necessary. The case met the criteria for definitive type b NS, as no extraneural involvement was identified. This case underscores the diagnostic challenges of isolated NS and highlights the importance of considering histopathological confirmation in patients without systemic manifestations to guide treatment. Glucocorticoids are first-line therapy, but rituximab may be effective as a second-line option for refractory cases. Early diagnosis and tailored therapy are essential to improving outcomes in this rare and challenging condition.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf014","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T15:29:11Z","timestamp":1736522951000},"source":"Crossref","is-referenced-by-count":4,"title":["Panhypopituitarism in Neurosarcoidosis: Pituitary-Hypothalamic Involvement Successfully Managed With Rituximab"],"prefix":"10.1210","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-305X","authenticated-orcid":false,"given":"Regina","family":"de Miguel Iba\u00f1ez","sequence":"first","affiliation":[{"name":"Endocrinology Service, Specialty Hospital of the National Medical Center Siglo XXI, Mexican Social Security Institute , Mexico City 06720 ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7590-7262","authenticated-orcid":false,"given":"Pattsy Etual","family":"Espinosa C\u00e1rdenas","sequence":"additional","affiliation":[{"name":"Endocrinology Service, Specialty Hospital of the National Medical Center Siglo XXI, Mexican Social Security Institute , Mexico City 06720 ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9216-0383","authenticated-orcid":false,"given":"Manuel Ram\u00f3n","family":"Garc\u00eda S\u00e1enz","sequence":"additional","affiliation":[{"name":"Endocrinology Service, Specialty Hospital of the National Medical Center Siglo XXI, Mexican Social Security Institute , Mexico City 06720 ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6819-3556","authenticated-orcid":false,"given":"Bayron A","family":"Sandoval Bonilla","sequence":"additional","affiliation":[{"name":"Neurosurgery Service, Specialty Hospital of the National Medical Center Siglo XXI, Mexican Social Security Institute , Mexico City 06720 ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"issue":"1","key":"2025020513055899000_luaf014-B1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s12883-016-0741-x","article-title":"Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis","volume":"16","author":"Fritz","year":"2016","journal-title":"BMC Neurol"},{"issue":"1","key":"2025020513055899000_luaf014-B2","doi-asserted-by":"crossref","first-page":"13735","DOI":"10.1038\/s41598-021-92967-6","article-title":"Clinical characterization and outcomes of 85 patients with neurosarcoidosis","volume":"11","author":"Ramos-Casals","year":"2021","journal-title":"Sci Rep"},{"issue":"10","key":"2025020513055899000_luaf014-B3","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1093\/qjmed\/hcs121","article-title":"Hypothalamo-pituitary sarcoidosis: a multicenter study of 24 patients","volume":"105","author":"Langrand","year":"2012","journal-title":"QJM"},{"issue":"11","key":"2025020513055899000_luaf014-B4","first-page":"e11481","article-title":"Hypothalamic-Pituitary axis dysfunction, central diabetes insipidus, and syndrome of inappropriate antidiuretic hormone secretion as the first clinical presentation of neurosarcoidosis: why early diagnosis and treatment is important?","volume":"12","author":"Blazin","year":"2020","journal-title":"Cureus"},{"issue":"14","key":"2025020513055899000_luaf014-B5","doi-asserted-by":"crossref","first-page":"e3277","DOI":"10.1097\/MD.0000000000003277","article-title":"Neurosarcoidosis in a tertiary referral center: a cross-sectional cohort study","volume":"95","author":"Leonhard","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"9","key":"2025020513055899000_luaf014-B6","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1515\/jpem-2019-0110","article-title":"Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review","volume":"32","author":"Sukumaran","year":"2019","journal-title":"J Pediatr Endocrinol Metab"},{"issue":"10","key":"2025020513055899000_luaf014-B7","doi-asserted-by":"crossref","first-page":"e235077","DOI":"10.1136\/bcr-2020-235077","article-title":"Neurosarcoidosis presenting with hypopituitarism","volume":"13","author":"Liu","year":"2020","journal-title":"BMJ Case Rep"},{"issue":"5","key":"2025020513055899000_luaf014-B8","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.beem.2009.05.009","article-title":"Pituitary tumours: inflammatory and granulomatous expansive lesions of the pituitary","volume":"23","author":"Carpinteri","year":"2009","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"12","key":"2025020513055899000_luaf014-B9","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1001\/jamaneurol.2018.2295","article-title":"Definition and consensus diagnostic criteria for neurosarcoidosis: from the neurosarcoidosis consortium consensus group","volume":"75","author":"Stern","year":"2018","journal-title":"JAMA Neurol"},{"key":"2025020513055899000_luaf014-B10","doi-asserted-by":"crossref","first-page":"970168","DOI":"10.3389\/fneur.2022.970168","article-title":"Epidemiology, clinical presentation, treatment, and outcome of neurosarcoidosis: a mono-centric retrospective study and literature review","volume":"13","author":"Sambon","year":"2022","journal-title":"Front Neurol"},{"key":"2025020513055899000_luaf014-B11","doi-asserted-by":"crossref","first-page":"1756286418805732","DOI":"10.1177\/1756286418805732","article-title":"Successful therapy with rituximab in three patients with probable neurosarcoidosis","volume":"11","author":"Zella","year":"2018","journal-title":"Ther Adv Neurol Disord"}],"container-title":["JCEM Case 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