Clinical presentation and management of hypophysitis: An observational study of case series

Abstract

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: 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: 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.

Coronavirus as a trigger of lymphocytic hypophysitis in an adolescent girl: An exceptional case report

“…However, our review of the four previous cases of autoimmune hypophysitis post-COVID-19 described hypopituitarism or central diabetes insipidus in three patients ( Table 2 ) [ 10 , 12 , 16 ]. It has been established that there was a predominant failure of thyroid and adrenal functions in hypophysitis, while GH and gonadotropin secretion would be affected to a slight degree [ 1 , 20 , 21 ].…”

“…MRI is the gold standard for evaluating the hypothalamic-pituitary region. There are several characteristic lesions of lymphocytic hypophysitis such as an homogenous and symmetric pituitary enlargement, loss of bright spot of the neurohypophysis on T1WI, intense homogenous enhancement post gadolinium on T1WI and T2WI, and thickening of the pituitary stalk [ 1 ]. The MRI of our patient demonstrated a pituitary enlargement measuring 9 mm in height and intense homogenous enhancement postgadolinium.…”

“…Hypophysitis is a chronic rare inflammatory disease of the pituitary gland. It can be responsible for hormonal deficiencies and mass effects [ 1 ]. Lymphocytic hypophysitis (LH) is an autoimmune affection and is more frequently observed in females during pregnancy or postpartum.…”

Autoimmune Hypophisitis: The Role of Magnetic Resonance Imaging in the Diagnosis and Monitoring of the Disease

“…Симптоматические проявления АГ неспецифичны. Для клинической картины гипофизита, вне зависимости от этиологии, характерны достаточно неспецифические жалобы на головную боль и нарушение зрения [5,7].…”

“…Лучевая диагностика воспалительных заболеваний гипофиза сопряжена с рядом трудностей, которые в большинстве случаев обусловлены схожестью признаков с такими опухолевыми заболеваниями гипофиза, как микро-и макроаденомы, ганглиоцитомы, зернисто-клеточные опухоли и др. По литературным данным, наиболее значимыми МРпризнаками АГ являются: симметричность поражения, утолщение воронки гипофиза без ее отклонения, характерное накопление контраста менингеальными структурами («dural tail») на сагиттальном срезе [1,7].…”