Cystic Lymphocytic Hypophysitis Mimicking Pituitary Apoplexy: Daunting Challenge

Hasegawa, Toshiharu; Ogiwara, Toshihiro; Nagm, Alhusain; Goto, Tetsuya; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

doi:10.1016/j.wneu.2018.06.230

Cited by 3 publications

(2 citation statements)

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“…A patient described in 2018 by Hasegawa et al 16 showed rapidly progressive hypophysitis on imaging concurrent with the development of a cystic lesion over 2 weeks. This was not associated with an ICI nor did the patient undergo resection to confirm the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…14 Diagnosis of ICI-induced hypophysitis requires diagnostic laboratory analysis including electrolytes and endocrine parameters such as thyroid-stimulating hormone, free T4, cortisol (baseline and The MRI features suggestive of hypophysitis include an enlarged triangular-or dumbbell-shaped pituitary gland with a thickened and not obviously deviated infundibulum, further supported by the absence of the posterior pituitary bright spot on T1-and T2-weighted images. 16 Contrast enhancement patterns are quite variable, including with dural enhancement. 17 Treatment of ICI-induced hypophysitis typically consists of systemic high-dose corticosteroids and hormone replacement therapy, but there remains some debate as to the utility of the latter and their effect on long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

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Pembrolizumab‐induced hypophysitis with acute progression of Rathke’s cyst

Gamblin

Twitchell

Kundu

et al. 2021

Clinical & Exp Neuroim

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Hypophysitis refers to sellar or suprasellar inflammation that leads to structural changes in the hypothalamic-pituitary axis and varying degrees of pituitary hormonal deficiencies. 1 Hypophysitis is a rare disorder that was first confirmed via magnetic resonance imaging (MRI) in the late 1980s, and the detected incidence has increased dramatically with improvements in imaging quality and understanding of the disease process. Over the past decade, the epidemiological landscape has changed as several newly described forms of hypophysitis have been described, 2 including one caused by immune checkpoint inhibitors (ICIs). Pembrolizumab, an ICI, is a U.S. Food and Drug Administration-approved monoclonal immunoglobulin G4 antibody that induces T-cell-mediated immune responses to various tumors. 3 Pembrolizumab has been established as a rare cause of ICIinduced hypophysitis. [4][5][6] Rathke's cleft cysts (RCCs) are benign lesions first described by Luska in 1860 as "an epithelial area in the capsule of human hypophysis resembling oral mucosa." 7 These benign cysts typically arise within the sella between the lobes of the pituitary. RCCs have been found in 4% to 33% of the population on autopsy. 8,9 Although most are asymptomatic, they can cause mass effect, leading to headaches, pituitary dysfunction, or visual disturbance. 10 Treatment for large or symptomatic cysts almost invariably involves surgical resection to evacuate the cyst and epithelium, typically via a transsphenoidal approach. 11 Small, asymptomatic lesions can be followed radiographically. 12 Despite the relative frequency of RCCs in the population, co-occurrence with ICI-induced hypophysitis has yet to be described.

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Section: Discussionmentioning

confidence: 99%