Postpartum Pituitary Hypophysitis

Tubridy, N; Molloy, Jane; Saunders, Dawn; Belli, Antonio; Michael, Powell; Plant, Gordon T.

doi:10.1097/00041327-200106000-00010

Cited by 16 publications

(4 citation statements)

References 8 publications

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“…However, endocrinological and neuroradiological improvement under pre-or postoperative high-dose corticosteroids is most often not only incomplete, but also only transient or even fails (8,10,14,20,(23)(24)(25)(26)(27)(28)(29). The only prospective trial of glucocorticoid use in lymphocytic hypophysitis showed that methylprednisolone reduced MRI mass in seven out of nine patients and improved anterior pituitary function in four patients (8,15,16,21).…”

Section: Lymphocytic (Nz21)mentioning

confidence: 99%

Primary hypophysitis: clinical-pathological correlations

et al. 2006

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Objective: Primary hypophysitis comprises of three distinct histomorphological entities: lymphocytic, granulomatous and xanthomatous. Clinical features of the three subtypes for diagnostic and treatment strategies have yet not been well characterized. Methods: Endocrine function, visual fields and acuity as well as magnetic resonance imaging characteristics were assessed before and after transphenoidal surgery in the largest series of 31 patients with primary hypophysitis (21 lymphocytic, 6 granulomatous, and 4 xanthomatous cases). Results: Only lymphocytic hypophysitis occurred during pregnancy (30%) and was associated with other autoimmune diseases (24%). Visual fields and acuity abnormalities were not seen in xanthomatous hypophysitis. Lymphocytic and granulomatous hypophysitis most often resulted in severe dysfunction of the adrenal, gonadal and thyroidal axes as well as diabetes insipidus. For patients presenting with xanthomatous hypophysitis most often, mild anterior pituitary axis failure was documented and posterior pituitary involvement was hardly found. The outcome after transphenoidal biopsy was generally favorable. Pre-or postsurgical glucocorticoid treatment was very effective in 75% of the lymphocytic form in reducing the pituitary size. In contrast, glucocorticoid therapy was less effective in granulomatous or xanthomatous hypophysitis. Conclusion: Diffuse destruction of the complete pituitary gland including the infundibulum has to be considered in lymphocytic and granulomatous hypophysitis, whereas in xanthomatous, a circumscribed anterior pituitary lesion leading to compression of the pituitary gland without alteration of the pituitary stalk and optic chiasm can be assumed.

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Section: Lymphocytic (Nz21)mentioning

confidence: 99%

Primary hypophysitis: clinical-pathological correlations

et al. 2006

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“…Additionally, corticotroph axis recovery and the need for rescue therapy were significantly better with very high dose glucocorticoids. Early involvement of ACTHsecreting cells in PAH and subsequent hypocortisolism has been proposed to be an underlying mechanism of perpetuating the autoimmune destruction of multiple tropic hormones (20). Hence, corticotroph axis recovery by higher doses (>100 mg/day) of glucocorticoids given intravenously may have a role in preventing damage to adjacent pituitary cell types and lead to better APH recovery.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis

Krishnappa

Shah

Memon

et al. 2023

Endocrine Connections

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Objectives: High-dose glucocorticoids are associated with improved recovery of deficits in primary autoimmune hypophysitis (PAH), but optimal dosing, route, and duration are unclear. Design: We reviewed literature for first-line glucocorticoid treatment in PAH until December 2021 and performed an individual-patient data meta-analysis to analyze clinical, hormonal, and radiological outcomes with respect to route, dose, and duration (<6.5 vs. 6.5-12 vs. >12 weeks) of glucocorticoid treatment according to disease severity. Results: 153 PAH patients from 83 publications were included. The median age at presentation was 41(32.5-48) years with a female preponderance (70.3%). Visual field recovery was significantly better with intravenous (91.7%) as compared to oral (54.5%) route, high dose (100%) and very-high dose (90.9%) as compared to medium dose (20%) of glucocorticoids. Corticotroph axis recovery was greater in intravenous (54.8% vs. 28.1% oral, p=0.033) route and increasing glucocorticoid dose group (0% vs. 38.1% vs. 57.1%), attaining statistical significance (p=0.012) with very high-dose. A longer duration of treatment (>6.5 weeks) was associated with better corticotroph and thyrotroph recovery. Need for rescue therapy with lower with intravenous route (38% vs 17.5%, p=0.012) and with increasing glucocorticoid doses (53.3% vs. 34.3% vs. 17.3%, p=0.016). In severe disease, visual field and corticotroph axis recovery was significantly higher with intravenous route and very-high dose steroids. The adverse effects of glucocorticoids were independent of dose and duration of treatment. Conclusions: Very high-dose glucocorticoids by intravenous route and cumulative longer duration (>6.5 weeks) lead to better outcomes and could be considered as first-line treatment of severe PAH cases.

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“…Lymphocytic hypophysitis is a rare but increasingly recognised pituitary disorder which affects women at the end of pregnancy or in the immediate post-partum period [1] most commonly, although it may occur independently of pregnancy in persons of either sex [2]. The aetiology is unknown but there is a relationship with other autoimmune diseases, particularly There are no features of adenoma, nor were granulomata seen.…”

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confidence: 99%

“…The differential diagnosis of this lesion includes an expanding pituitary adenoma or meningioma, both of which may enlarge considerably during pregnancy [8], infective processes such as tuberculosis, pyogenic or fungal sinus disease or mucocoele, and granulomatous disease, particularly sarcoidosis which may commonly affect the hypothalamus and pituitary [9]. No other case has been reported so early in pregnancy and hence a clear treatment protocol during pregnancy is required; in post-partum cases a trial of steroids seems justified, with recourse to surgery only if the lesion fails to resolve or grows larger, as advocated by Tubridy et al [1]; similarly in very late pregnancy the same treatment plan can be used, or a delay in surgery until after a planned caesarian section. What, therefore should be done in the middle trimester?…”

mentioning

confidence: 99%