Imaging findings in hypophysitis: a review

Caranci, Ferdinando; Leone, Giuseppe; Ponsiglione, Andrea; Muto, Massimo; Tortora, Fabio; Muto, Mario; Cirillo, S.; Brunese, Luca; Cerase, Alfonso

doi:10.1007/s11547-019-01120-x

Cited by 56 publications

(51 citation statements)

References 46 publications

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“…are less common. Nevertheless, many other lesions in sellar region may present overlapping symptoms, such as craniopharyngiomas, Rathke's cleft cysts, meningiomas, gliomas, dysgerminomas, cysts, hamartomas, metastases, focal areas of infarction (50) and lymphocytic infiltration (51). Thus, the differential diagnosis of sellar masses is not straightforward.…”

Section: Resultsmentioning

confidence: 99%

Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood

et al. 2020

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Section: Resultsmentioning

confidence: 99%

Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood

et al. 2020

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“…MRI is initially performed and monitored during the first 3 months of follow-up and thereafter according to disease progression [70]. Features suggestive of hypophysitis include an intense and enlarged triangular- or dumbbell-shaped homogenously enhancing gland with a thickened but not deviated stalk and absence of the posterior pituitary bright spot in patients with DI [71]. Empty sella may also represent a late finding in hypophysitis [53, 72].…”

Section: Resultsmentioning

confidence: 99%

“…Empty sella may also represent a late finding in hypophysitis [53, 72]. The presence of pituitary stalk thickening, in the appropriate clinical setting, is perhaps the strongest predictor of an inflammatory process [71]. These features are most prominent in LH that exhibits symmetric pituitary enlargement, pre-contrast homogeneity, and strips of involved area which resembles contrast-enhancing tissue along the dura mater, termed “dural tail” or “meningeal tail” [1, 4, 73] (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…MRI-specific findings for GH, albeit less well described, include pituitary enlargement and pituitary stalk thickening [56]. XH presents as cystic sellar mass, peripherally enhancing on post-gadolinium contrast images [71]. NH shows nonspecific MRI findings, including symmetrical enlargement of the pituitary gland without signs of hemorrhage, and thickened and pathologically enhancing stalk [53].…”

Section: Resultsmentioning

confidence: 99%

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Hypophysitis (Including IgG4 and Immunotherapy)

et al. 2020

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Hypophysitis is characterized by inflammation of the pituitary gland that can be primary (PH) or secondary (SH) to other diseases or following drug administration. It may also be classified according to anatomical and histopathological criteria, leading to variable degrees of hypopituitarism and/or compressive symptoms to nearby structures. There has recently been an increase in the number of hypophysitis cases, raising the interest on the spectrum of its pathogenesis, clinical, biochemical/endocrinological, and imaging features. However, the use of conventional biomarkers, including currently utilized pituitary autoantibodies, has relatively limited diagnostic accuracy. Lymphocytic hypophysitis (LH) is the commonest cause of PH, whereas IgG4-related hypophysitis is increasingly being recognized. Histiocytosis and granulomatous diseases are the most frequent causes of SH, although infections and lymphoma have also been reported. The increasing use of immune checkpoint inhibitors in oncology is associated with a high incidence of hypophysitis, providing further understanding of its pathogenesis. Hy-pophysitis can occur silently and be easily missed, potentially leading to substantial morbidity or mortality due to adrenal insufficiency, requiring a high index of clinical suspicion and timely initiation of appropriate treatment. In most cases of LH or drug-induced hypophysitis, active surveillance along with replacement of established hormonal deficiencies is needed. In the presence of compressive and/or evolving symptoms, treatment with glucocorticoids either alone or in combination with other immunosuppressive agents can be used. Surgical decompression is reserved for nonresponsive cases with threatened vital structures. Timely diagnosis and intervention are important to minimize disease-related morbidity and mortality. We aimed to review current concepts and recent developments in the pathogenesis, diagnosis, and management of hypophysitis.

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“…Unfortunately, imaging techniques, such as MRIs, may not help diagnose ICI-related CDI/hypophysitis, since pituitary MRI may be normal in patients diagnosed with hypophysitis and/or CDI (4)(5)(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Ipilimumab-Induced Panhypophysitis: An Infrequent Occurrence and Literature Review

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BackgroundImmune checkpoint inhibitors (ICIs), by unleashing the anticancer response of the immune system, can improve survival of patients affected by several malignancies, but may trigger a broad spectrum of adverse events, including autoimmune hypophysitis. ICI-related hypophysitis mainly manifests with anterior hypopituitarism, while the simultaneous involvement of both anterior and posterior pituitary (i.e., panhypophysitis) has rarely been described.Case PresentationIn June 2015, a 64-year-old man affected by liver metastases of a uveal melanoma was referred to us due to polyuria and polydipsia. Two months prior, he had started ipilimumab therapy (3 mg/kg iv every 21 days). The treatment was well-tolerated (only mild asthenia and diarrhea were reported). A few days before the fourth cycle, the patient complained of intense headaches, profound fatigue, nocturia, polyuria (up to 10 L urine/daily), and polydipsia. Laboratory tests were consistent with adrenal insufficiency, hypothyroidism, and transient central diabetes insipidus. The pituitary MRI showed an enlarged gland with microinfarcts, while the hypophyseal stalk was normal, and the neurohypophyseal ‘bright signal’ in T1 sequences was not detected. The treatment included dexamethasone (then cortisone acetate at replacement dose), desmopressin, and levothyroxine. Within the next five days, the symptoms resolved, and blood pressure, electrolytes, glucose, and urinalysis were stable within the normal ranges; desmopressin was discontinued while cortisone acetate and levothyroxine were maintained. The fourth ipilimumab dose was entirely administered in the absence of further side effects.ConclusionAs ICIs are increasingly used as anticancer agents, the damage to anterior and/or posterior pituitary can be progressively encountered by oncologists and endocrinologists in their clinical practice. Patients on ICIs and their caregivers should be informed about that risk and be empowered to alert the referring specialists early, at the onset of panhypopituitarism symptoms, including polyuria/polydipsia.

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Imaging findings in hypophysitis: a review

Cited by 56 publications

References 46 publications

Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood

Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood

Hypophysitis (Including IgG4 and Immunotherapy)

Case Report: Ipilimumab-Induced Panhypophysitis: An Infrequent Occurrence and Literature Review

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