Hormone replacement and, in selected cases, careful observation are advised with imaging follow-up. High-dose glucocorticoids are initiated mainly to help reduce the mass effect. A response may be observed in all auto-immune etiologies, as well as in lymphoproliferative diseases, and, as such, should not be used for differential diagnosis. Surgery may be necessary in some cases to relieve mass effects and allow a definite diagnosis. Immunosuppressive therapy and radiation are sometimes also necessary in resistant cases 1). 2) 3) 4)