Endocrine Abstracts

Hypophysitis is a rare clinical condition manifesting as pituitary dysfunction: hypopituitarism or diabetes insipidus (DI) and pituitary enlargement causing mass effect (headaches, visual disturbances) due to the inflammation of the pituitary gland. We conducted a retrospective analysis of medical records of patients diagnosed with hypophysitis in the Department of Endocrinology of the Bielanski Hospital from 2014 to 2019. Twenty-five patients were identified, which represents 0.3% of all patients hospitalized at the Department during that period. Women predominance was noted (80% females and 20% males) and a mean age of patients was 40.6 ± 16.2 years. No association with pregnancy and labour was present except for one patient. Primary hypophysitis was suspected in most cases. Secondary hypophysitis was recognized in 3 patients – one with Langerhans cell histiocytosis and two immunotherapy induced. Diagnosis was based on clinical picture, hormonal and imaging results. No histopathologic confirmations were available in 23 cases. The most common symptoms at presentation were headaches and DI (52% of cases each). Anterior pituitary dysfunction was frequently present – at least one tropic hormone deficiency was found in 60% of patients. Gonadotroph deficiency was the most frequent (48%), followed by TSH and ACTH deficiencies (in 44% and 40%, respectively). Panhypopituitarism was present in 7 cases (28%) and in 5 of those accompanied by DI. Hyperprolactinemia occurred less frequently, in 20% of cases. Visual disturbances caused by optic chiasm compression/infiltration or cranial nerves palsies were present in 9 cases (36%). The most frequent finding on MRI scans was the lack of posterior lobe bright spot (n = 14, 56%). Pituitary stalk thickening, pituitary enlargement alone or together with stalk thickening were present in 9 (36%), 7 (28%) and 7 (28%) cases, respectively. In one patient a unilateral internal carotid artery occlusion was found and in another patient the inflammation extend to hypothalamus. Nine patients with visual disturbances and severe headache were treated with high-doses of glucocorticosteroids with partial or complete resolution of symptoms, but in 4 patients relapses were observed.

Conclusion: Hypophysitis typically occurs in middle-aged woman without relationship to recent pregnancy. The most frequent symptoms at presentation are headaches and DI. The most common anterior pituitary deficiency is a gonadotroph deficiency, not isolated corticotroph deficiency as previously stated. High-dose glucocorticosteroids treatment exerts a positive effect in the form of at least partial relief of symptoms, especially headaches.