Endocrine Abstracts

Introduction: Hypophysitis is a very rare and heterogenous condition characterized by pituitary inflammation that leads to hypopituitarism, diabetes insipidus and symptoms associated with mass effect such as headaches and visual disturbances. Studies on large groups of patients with hypophysitis are scarce. The aim: We performed an analysis of clinical symptoms, pituitary function, and management of patients diagnosed with hypophysitis.

Material and Methods: This was a retrospective single-centre study of 30 consecutive patients diagnosed with hypophysitis in the Department of Endocrinology at Bielanski Hospital in Warsaw for the last 10 years (between 2014 and 2023). We evaluated medical records of the patients, hormonal and MRI results, and treatment outcomes.

Results: Patients with hypophysitis represented 0.38% of all patients admitted to the Department during this period. Female gender was predominant (78.1%) but the association with pregnancy occurred only in one case. The mean age at diagnosis was 41.9±15.5 years and ranged from 15 to 71 years. The most common symptoms at diagnosis were headache (43.8%) and diabetes insipidus (56.3%). The gonadotropic, thyrotropic and corticotropic axis were affected in 65.6%, 56.3% and 59.4%, respectively. The most typical MRI findings were infundibular thickening (65.6%), enlarged pituitary gland (56.6%) and the lack of typical posterior pituitary signal in T1-weighted images (25.0%). Diagnosis of hypophysitis was mostly based on clinical presentation, laboratory and imaging results, and the response to glucocorticoid treatment. Histopathological diagnosis was confirmed in 4 patients (13.3%). There were 6 cases of secondary hypophysitis - 2 sarcoidosis, 1 Langerhans’s cell histiocytosis and 3 induced by immune checkpoint inhibitors. The remaining cases were diagnosed as primary hypophysitis. Nine patients (30.0%) had positive anti-thyroid antibodies and the autoimmune thyroid disease was the most common autoimmune disease in a family history. Twelve patients (37.5%) received high-dose glucocorticosteroid therapy with prompt improvement of symptoms. However the relapse of the disease was observed in 4 of them. Two patients with a recurrent hypophysitis received a second line treatment with azathioprine and mycophenolate mofetil and they have remained in remission.

Conclusions: The diagnosis of hypophysitis is commonly made based on the clinical, radiological, and hormonal picture. It typically occurs in middle-aged women but pregnancy does not seem to be a risk factor. Our results confirmed that the gonadotropic axis was the most frequently affected. Treatment with high-dose glucocorticosteroids had a beneficial effect in terms of at least partial relief of symptoms, especially headaches.