Endocrine Abstracts

Introduction: Lymphocytic hypophysitis (LH) is a rare condition that has been increasingly recognised. We studied the natural history and current management of patients with lymphocytic hypophysitis.

Methods: We performed a multi-centre retrospective review of all patients that either had histologically proven disease or a strong clinical suspicion for its presence, diagnosed from 2000 onwards. Cases of secondary hypophysitis or granulomatous or xanthomatous or other mixed forms of primary hypophysitis were excluded.

Results: Of 20 patients included 16 (80%) were females, 18 (90%) were Caucasians and the mean age was 39.5 years. Ten out of 16 (62.5%) females presented either in the antepartum or the post-partum period. Headache was the commonest presenting complain (13/20, 65%), followed by visual field impairment (7/20, 35%). Anterior, posterior and combined hypopituitarism was observed in 19/20 (95%), 7/20 (35%) and 6/20 (30%) respectively. Stratification into individual hormone deficiencies showed that ACTH deficiency was the most prevalent affecting 18/20 (90%) patients, followed by TSH, LH/FSH, GH, ADH and prolactin deficiencies. The duration of symptoms prior to a diagnosis had been made ranged for many months to a few years, for at least half the patients. Surgery was peformed in 9/20 (45%) for the following indications: visual field disturbances (6) and severe headache (2). The remaining cases were medically managed. At follow-up there were no fatalities. At 1 year follow-up all (18/18) patients were still requiring ≥1 hormone replacement; symptomatology (mainly headaches) persisted in 8/18 (42.1%) and 2/18 (11.1%) of patients had residual visual field defects.

Discussion: We report a pragmatic study of the current practices of LH. We would like to emphasize the favourable prognosis of this condition, but at the same time the high morbidity associated with it; of concern there remains a long delay between the appearance of symptoms and the diagnosis been reached.