Endocrine Abstracts

BACKGROUND: Lymphocytic hypophysitis (LHy) is an uncommon inflammatory disorder of the pituitary with features mimicking those of sellar tumours, thereby often being misdiagnosed. However, no long-term follow-up studies have been published.

OBJECT: To evaluate the clinical/radiological characteristics and the prognosis of patients with LHy.

PATIENTS-METHODS: The records of the patients who presented to the Department of Endocrinology with histologically confirmed LHy between 1976-2004 were reviewed.

RESULTS: Eleven patients were identified (8 females). The median age at diagnosis was 35 years (range: 16-60). The median follow-up was 32 months (4-185). A history of autoimmune disease was noted in 27% of the patients. The median duration of symptoms until diagnosis was 20(2-96) months. In only 2 cases there was a relation to pregnancy. The presenting manifestations included endocrine dysfunction(91%), headache(82%), visual fields defects(45%) and diplopia(18%). Hypogonadism was found in 82% of the patients, hyperprolactinaemia and hypoadrenalism in 64%, DI in 36% and hypothyroidism in 27%. No isolated ACTH or TSH deficiency was noted. One female had low prolactin. Imaging (CT or MRI) revealed an enhancing pituitary mass without suprasellar extension in 2 and with a suprasellar component in 6 patients. Seven patients underwent transphenoidal removal of the mass and 4 only transphenoidal biopsy. In the latter group, two received no treatment, one had steroids and one steroids and radiotherapy for space occupation. There was no recurrence during follow-up. Visual function was restored in all patients and prolactin was normalised in 5(71%). Partial recovery of the pituitary function occurred in 2 subjects after surgery, in one treated with steroids and in one without treatment.

CONCLUSIONS: LHy can present as an acute and aggressive disease or in a more insidious way. Steroids or surgery can be an effective treatment and pituitary function may recover. The long-term prognosis of these patients is good.