Endocrine Abstracts

Introduction: Clinical manifestation of hypophysitis depends on presence of hormonal abnormalities and/or enlargement of pituitary structures. Both the diagnosis and treatment still remain challenging. Hormonal replacement is the basic therapy, while steroids are the first-line treatment in case of mass related symptoms. The course of the disease varies from spontaneous remission to atrophy of the pituitary gland.

Aim: To characterize and sum up clinical/hormonal/radiological findings and therapeutic approach in patients with probable lymphocytic hypophysitis.

Methods: A retrospective analysis of 12 patients (9W/3M) with probable lymphocytic hypophysitis hospitalized in our Department (2015-2022) was performed. Clinical, laboratory and imaging findings were assessed. The study is a part of a project “Assessment of the health condition of patients with hypopituitarism in Poland” (grant N41/DBS/000408).

Results: Mean age at diagnosis was 49.2 years (48.2 for W, 52.0 years for M). Headaches and diabetes insipidus were the first manifestation in 7/12 and 3/12 cases, respectively, while 2/12 patients presented with clinical symptoms of adrenal insufficiency. In one patient hypocortisolism was transient, in the second case reassessment is difficult due to inhaled and oral steroids used by patient in asthma exacerbations. 5/12 patients were diagnosed with diabetes insipidus (one temporary) and gonadal axis dysfunction was detected in 5/12 cases (one transient). Central hypothyroidism was found in 4/12 patients – in all cases permanent. Probable GH deficit (based on lower insulin-like growth factor 1 concentration) was suspected in 5/12 patients (one transient). One patient had no hormonal abnormalities. Magnetic resonance (MR) revealed thickened pituitary stalk (max. 11 mm) in all but one cases; in two – lack of the posterior lobe signal. In one patient the area of inflammation within the anterior pituitary lobe was described. The hormonal substitution was administered appropriately to the deficits; due to the severe headaches 3 patients were given steroids (2 in intravenous pulses, one orally) with subsequent reduction in the frequency and severity of complaints and stable/improved image of pituitary area in the control MR. One woman was operated due to the progression in the pituitary tumor size and mass effect-related symptoms – histopathological examination confirmed lymphocytic hypophysitis. In the remaining 8/12 patients watchful waiting approach allowed to obtain hormonal and radiological stabilization/improvement.

Conclusions: Non-specific, transient characteristic of the symptoms and hormonal deficits cause difficulties in establishing proper diagnosis. The treatment may vary depending on the clinical and hormonal status. Further research and long term observation might help in better understanding of the disease.