Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system

Wright, Kyla; Kim, Hyon; Hill, Travis C.; Lee, Matthew; Orillac, Cordelia; Mogar, Nikita; Pacione, Donato; Agrawal, Nidhi

doi:10.1007/s11102-022-01232-0

Cited by 8 publications

(7 citation statements)

References 43 publications

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“…To our knowledge, there are few reports on the imaging findings of IgG4-RH, although there have been a few reports of the imaging findings of IgG4-RD in the head and neck[ 15 , 16 ]. Based on previous reports[ 17 , 18 ] and the imaging findings in this case, the imaging findings of IgG4-RH are enlargement of pituitary and/or pituitary stalk with a clear boundary and regular morphology. Necrosis and calcification are rare and the diagnosis should be questioned if they are present[ 7 , 16 ].…”

Section: Discussionmentioning

confidence: 56%

Imaging findings of immunoglobin G4-related hypophysitis: A case report

Lv¹,

Cao²,

Geng³

et al. 2022

WJCC

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BACKGROUND Immunoglobin G4 (IgG4)-related hypophysitis (IgG4-RH) is a rare form of IgG4-related disease (IgG4-RD), which often manifests as a single organ disease and is easily misdiagnosed as a pituitary tumor clinically and by imaging. There are few reports of imaging findings of IgG4-RH. Therefore, we describe a case of IgG4-RH, which mimicked a pituitary macroadenoma, that was detected by computed tomography (CT) and magnetic resonance imaging (MRI), and review the previous literature in order to further the understanding of IgG4-RH. CASE SUMMARY A 47-year-old man presented with a history of blurred vision for more than 2 mo, without other symptoms. A preoperative unenhanced CT scan revealed a slightly hyperdense mass in the sellar region measuring 2.5 cm × 2.3 cm × 1.8 cm, with a CT value of 45 HU. T1-weighted imaging (T1WI) and T2-weighted imaging showed iso-hypointensity, and gadolinium contrast-enhanced T1WI showed obvious homogeneous enhancement. The MRI revealed involvement of the pituitary gland and stalk. Preoperative laboratory tests revealed abnormal pituitary hormone levels, including an increased prolactin level, and decreased levels of insulin-like growth factor, dehydroepiandrosterone, and testosterone. The lesion was surgically resected. Postoperative histopathological examination of a tissue sample and an elevated serum IgG4 level confirmed the diagnosis of IgG4-RH. The patient was treated with cortisone acetate postoperatively and made a good recovery without developing any neurological deficit. CONCLUSION An elevated serum IgG4 concentration is the main clue for diagnosis of IgG4-RD. Imaging combined with laboratory testing is useful for preoperative diagnosis of IgG4-RH.

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Section: Discussionmentioning

confidence: 56%

Imaging findings of immunoglobin G4-related hypophysitis: A case report

Lv¹,

Cao²,

Geng³

et al. 2022

WJCC

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“…The most common form is lymphocytic, followed by granulomatous hypophysitis [ 2 , 16 ]. Hypophysitis can radiologically mimic other nonfunctioning masses [ 17 ]. There is a spectrum of the symptomatic manifestations; hypophysitis can remain asymptomatic, cause mild endocrine deficiencies and mass effect, or result in major endocrine deficiencies and death [ 5 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hypophysitis can radiologically mimic other nonfunctioning masses [ 17 ]. There is a spectrum of the symptomatic manifestations; hypophysitis can remain asymptomatic, cause mild endocrine deficiencies and mass effect, or result in major endocrine deficiencies and death [ 5 , 17 ]. Clinically, infundibuloneuro- and panhypophysitis present with diabetes insipidus (DI) and antidiuretic hormone deficiency, whereas anterior pituitary involvement alone typically does not result in DI; rather, it can result in anterior pituitary hormone deficiencies [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Tissue biopsy is the gold standard; however, magnetic resonance imaging (MRI) is most often used to support a definitive diagnosis. Common features include infundibular thickening and the absence of cavernous sinus invasion, especially within the context of new-onset DI or an onset with a close temporal relationship to pregnancy [ 17 ]. Several antibodies to pituitary antigens have been identified as possible serum markers of hypophysitis, including those against growth hormone, alpha enolase, secretograinin-2, pituitary gland-specific factors 1a and 2, TPIT, PIT1, and chorionic somatomammotropin [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Hypophysitis: Defining Histopathologic Variants and a Review of Emerging Clinical Causative Entities

Rawanduzy

Winkler-Schwartz

Couldwell

2023

IJMS

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Inflammatory disease of the pituitary gland is known as hypophysitis. There are multiple histological subtypes, the most common being lymphocytic, and the pathogenesis is variable and diverse. Hypophysitis can be primary and idiopathic or autoimmune related, or secondary to local lesions, systemic disease, medications, and more. Although hypophysitis was previously accepted as an exceedingly rare diagnosis, a greater understanding of the disease process and new insights into possible etiologic sources have contributed to an increased frequency of recognition. This review provides an overview of hypophysitis, its causes, and detection strategies and management.

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“…Based on the biological behavior, pituitary adenoma can be classified into benign adenoma, invasive adenoma and carcinoma [2]. Although most pituitary adenoma are not cancerous, they can lead the pituitary to produce abnormal hormones, resulting in health problems [3][4][5]. Usually, it causes endocrine metabolic disorders and is harmful to the corresponding target organs.…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of AZD9496 and Fulvestrant on the Growth of Pituitary Adenoma via Blocking JAK2/STAT5B Pathway

Liu¹,

Shen²,

Xiong³

et al. 2023

J. Cancer

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Total 158 gonadotropin-type pituitary adenoma tissue specimens were collected and the expression of ESR1 in gonadotropin-type pituitary adenoma and its association with the overall survival of patients were analyzed. Transcriptome-sequencing data containing 79 cases of gonadotropin-type pituitary adenoma was used to search for all ESR1-related genes. KEGG pathway enrichment analysis was performed to identify the altering pathway and targeting genes. The in vitro and in vivo pituitary models were used to evaluate the therapeutic efficacy of estrogen receptor (ER) inhibitors AZD9496 and fulvestrant. The mechanism of AZD9496 and fulvestrant in suppressing pituitary adenoma were also investigated. Low-level ESR1 had longer progression-free survival (PFS) in pituitary adenoma patients. ErbB signaling pathway was discovered as the main enriched pathway. Furthermore, the STAT5B gene was identified as a key ESR-1-related gene. The expression of STAT5B was significantly positively correlated with ESR1 expression in the pituitary adenoma. AZD9496, a novel ER inhibitor, exhibited a potent inhibitory effect on the growth of in vitro and in vivo pituitary adenoma cells, and its efficacy is comparable to the classic ER inhibitor, fulvestrant. Mechanically, the AZD9496 and fulvestrant significantly blocked JAK2/STAT5B pathway in GT1-1 cells and xenograft mice. Our results provide substantial evidence for the subsequent clinical use of AZD9496 in the treatment of patients with pituitary adenoma.

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Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system

Cited by 8 publications

References 43 publications

Imaging findings of immunoglobin G4-related hypophysitis: A case report

Imaging findings of immunoglobin G4-related hypophysitis: A case report

Hypophysitis: Defining Histopathologic Variants and a Review of Emerging Clinical Causative Entities

Comparative Efficacy of AZD9496 and Fulvestrant on the Growth of Pituitary Adenoma via Blocking JAK2/STAT5B Pathway

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