Among the endocrine glands, the pituitary is the most frequently affected in a manner giving rise to functional effects. The tendency of sarcoidosis to involve the meninges and neural structures at the base of the brain has been noted in Chapter 14. The variability of distribution and localization of hypothalamic-pituitary changes gives rise to a wide range of clinical syndromes. These include secondary effects on other endocrine glands, which do not appear to be specially liable to persistent granulomatous invasion in sarcoidosis. In some reported cases, granulomas have been found in thyroid, parathyroids or pancreas with no evident functional effects; and when endocrine dysfunction has been observed, it has been arguable in most cases whether this is a direct effect of sarcoid infiltration, indirectly linked to sarcoidosis through unidentified common immunological factors, or simply coincidental with and aetiologically unrelated to sarcoidosis. Sarcoid granulomas have very rarely been found in the adrenal glands.