Clinical presentation and management of hypophysitis: An observational study of case series.
Central diabetes insipidus
Corticosteroids
Hormone replacement
Hypophysitis
Hypopituitarism
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2021
2021
Historique:
received:
08
05
2021
accepted:
24
05
2021
entrez:
4
8
2021
pubmed:
5
8
2021
medline:
5
8
2021
Statut:
epublish
Résumé
Hypophysitis is described as a rare chronic inflammatory affection of the pituitary gland. However, to date, its pathogenesis has not been completely cleared up. Clinical features are polymorphic, including symptoms related to inflammatory compression and/or hypopituitarism. Laboratory tests determine hormone deficiencies orientating replacement therapy's protocol. MRI of the hypothalamic-pituitary region is crucial in exhibiting major radiological signs such as pituitary homogeneous enlargement and gland stalk's thickening. The etiological diagnosis is still challenging without affecting the management strategy. Corticosteroids have widely been used but a close follow-up without any treatment has also been approved. In this report, seven patients with hypophysitis have been collected over a period of 6 years. The average age of our patients was 32.1 years ± 11.8 with a female predominance (71.4%). Panhypopituitarism was objective in 42.9% of cases, a combined deficiency of the hypothalamic-pituitary thyroid, adrenal and gonadal axes in 28.6% of cases. A central diabetes insipidus was noted in 42.9% of the patients. Idiopathic hypophysitis was the most common etiology. The use of long course corticosteroids was required in 28.6% when compressive signs were reported. Hypophysitis remains a rare disease with nonspecific clinical and radiological patterns. Autoimmune origin seems to be the most frequent etiology. No guidelines have been established for hypophysitis management and the evolution is still unpredictable.
Sections du résumé
BACKGROUND
BACKGROUND
Hypophysitis is described as a rare chronic inflammatory affection of the pituitary gland. However, to date, its pathogenesis has not been completely cleared up. Clinical features are polymorphic, including symptoms related to inflammatory compression and/or hypopituitarism. Laboratory tests determine hormone deficiencies orientating replacement therapy's protocol. MRI of the hypothalamic-pituitary region is crucial in exhibiting major radiological signs such as pituitary homogeneous enlargement and gland stalk's thickening. The etiological diagnosis is still challenging without affecting the management strategy. Corticosteroids have widely been used but a close follow-up without any treatment has also been approved.
CASE DESCRIPTION
METHODS
In this report, seven patients with hypophysitis have been collected over a period of 6 years. The average age of our patients was 32.1 years ± 11.8 with a female predominance (71.4%). Panhypopituitarism was objective in 42.9% of cases, a combined deficiency of the hypothalamic-pituitary thyroid, adrenal and gonadal axes in 28.6% of cases. A central diabetes insipidus was noted in 42.9% of the patients. Idiopathic hypophysitis was the most common etiology. The use of long course corticosteroids was required in 28.6% when compressive signs were reported.
CONCLUSION
CONCLUSIONS
Hypophysitis remains a rare disease with nonspecific clinical and radiological patterns. Autoimmune origin seems to be the most frequent etiology. No guidelines have been established for hypophysitis management and the evolution is still unpredictable.
Identifiants
pubmed: 34345445
doi: 10.25259/SNI_454_2021
pii: 10.25259/SNI_454_2021
pmc: PMC8326108
doi:
Types de publication
Case Reports
Langues
eng
Pagination
304Informations de copyright
Copyright: © 2021 Surgical Neurology International.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
Eur J Endocrinol. 2006 Jul;155(1):101-7
pubmed: 16793955
J Clin Endocrinol Metab. 2013 May;98(5):1865-8
pubmed: 23650339
Br J Neurosurg. 2001 Jun;15(3):242-5, discussion 245-6
pubmed: 11478060
J Pathol Bacteriol. 1962 Apr;83:584-5
pubmed: 13900798
J Neurol Neurosurg Psychiatry. 1999 Sep;67(3):398-402
pubmed: 10449568
Eur J Endocrinol. 2013 Dec 21;170(2):161-72
pubmed: 24165017
AJNR Am J Neuroradiol. 2009 Oct;30(9):1766-72
pubmed: 19628625
Endocrinol Metab Clin North Am. 2015 Mar;44(1):143-9
pubmed: 25732650
Ann Endocrinol (Paris). 2012 Oct;73 Suppl 1:S17-25
pubmed: 23089377
Pituitary. 2014 Aug;17(4):357-65
pubmed: 23990347
Pituitary. 2015 Feb;18(1):16-22
pubmed: 24375060
Autoimmun Rev. 2008 Sep;7(8):631-7
pubmed: 18774118
J Clin Endocrinol Metab. 2015 Oct;100(10):3841-9
pubmed: 26262437
Endocrinol Metab (Seoul). 2014 Dec 29;29(4):470-8
pubmed: 25325267
Eur J Endocrinol. 1998 Jan;138(1):89-91
pubmed: 9461323
J Clin Endocrinol Metab. 2012 Oct;97(10):3684-90
pubmed: 22855340
Endocr Rev. 2005 Aug;26(5):599-614
pubmed: 15634713
Clin Diabetes Endocrinol. 2016 Sep 6;2:15
pubmed: 28702249
J Endocrinol Invest. 2011 Sep;34(8):e245-52
pubmed: 21750396
Minerva Endocrinol. 2016 Sep;41(3):390-9
pubmed: 26963662
J Clin Endocrinol Metab. 2015 Sep;100(9):3460-9
pubmed: 26091204
Endocrinology. 2011 Nov;152(11):4190-8
pubmed: 21862619
Oncol Lett. 2016 Feb;11(2):1315-1320
pubmed: 26893737
Pituitary. 2015 Oct;18(5):630-41
pubmed: 25534888
Ann Endocrinol (Paris). 2012 Apr;73(2):76-7
pubmed: 22516764
Am J Surg Pathol. 1998 Jun;22(6):736-41
pubmed: 9630181
Neurosurgery. 1997 Apr;40(4):713-22; discussion 722-3
pubmed: 9092844