Endocrine Abstracts

Four patients with autoimmune hypophysitis were followed since the diagnosis of the disease. All presented with severe headache, decreased libido, astenia. Case 1 and 3 presented polyuria and polydipsia. At MRI pituitary was enlarged, with high gadolinum uptake and stalk enlargement.

Case 1, male 41 years. MRI volume: AP 13 mm, CC 7 mm. Hormonal assessment: central hypothyroidism, hypoadrenalism, hypogonadism, normal GH and IGF1, hyperprolactinemia, central diabetes insipidus. Pituitary biopsy: severe lymphomonocitic infiltrate. Case 2, male 54 years. MRI volume: AP 13.5 mm, CC 7.7 mm. Hormonal assessment: central hypothyroidism, hypoadrenalism, hypogonadism, GH deficiency, hyperprolactinemia. Case 3, male 74 years. MRI volume: AP 9 mm, CC 7 mm. Hormonal assessment: panhypopituitarism, central diabetes insipidus. Pituitary biopsy: rich IgG4 lymphomonocitic infiltration. Case 4, female 35 years. MRI volume: AP 16 mm, CC 7 mm. Hormonal assessment: panhypopituitarism, hyperprolactinemia. All patients were treated by oral prednisone therapy (starting dose: 40 mg/day gradually tapered over 6 months) and followed with regular hormonal exams and pituitary MRI. At the last outpatient visit: Case 1 (6 years AR): recovery of gonadic and thyroid function, GH deficiency, adrenal insufficiency and diabetes insipidus remained unchanged. MRI: shrinked pituitary (AP 8 mm, CC 4 mm). Case 2 (1 year AR): complete recovery of adrenal function, persistence of hypogonadism and GH deficiency, subclinical hypopthyroidism. MRI: shrinked pituitary (AP 11 mm, CC 2.5 mm). Case 3 (6 years AR) persistence of panhypopituitarism and diabetes insipidus. MRI: shrinked pituitary (AP 6 mm, CC 4 mm). Case 4 (1 year AR) complete recovery of pituitary function. MRI: normal pituitary volume (AP 12 mm, CC 4 mm).

Conclusion: Glucocorticoid treatment is effective in improving pituitary function and pituitary mass. Over the years new hormonal defects may appear along with pituitary shrinkage: empty sella might be the outcome of autoimmune hypohysitis. (abbreviations: AR, after remission; AP, antero–posterior diameter; CC, cranio-caudal diameter).