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open access

Vol 70, No 3 (2019)
Review paper
Submitted: 2019-02-08
Accepted: 2019-02-28
Published online: 2019-06-30
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Hypophysitis — new insights into diagnosis and treatment

Łukasz Kluczyński1, Aleksandra Gilis-Januszewska12, Damian Rogoziński1, Jacek Pantofliński1, Alicja Hubalewska-Dydejczyk12
DOI: 10.5603/EP.a2019.0015
·
Pubmed: 31290557
·
Endokrynol Pol 2019;70(3):260-269.
Affiliations
  1. Department of Endocrinology, University Hospital in Krakow, Krakow, Poland
  2. Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland

open access

Vol 70, No 3 (2019)
Review Article
Submitted: 2019-02-08
Accepted: 2019-02-28
Published online: 2019-06-30

Abstract

Hypophysitis is a broad term used to describe conditions leading to inflammation of the pituitary gland and the pituitary stalk. It may develop as a primary condition or secondary to other diseases. Hypophysitis is classified based on aetiological, anatomical, and histological criteria. Clinical symptoms result from enlargement of the pituitary gland, hormonal deficiencies, diabetes insipidus, and hyperprolactinemia. Histopathological verification of tissue samples from a pituitary biopsy remains the gold standard in diagnosing hypophysitis. However, due to the invasiveness and risk of the procedure it is rarely performed. The diagnosis is based mainly on clinical presentation, laboratory tests, and imaging. The rarity of the disease and the deficit in reliable data result in a lack of clear guidelines in the treatment of hypophysitis. The basic therapy relies on hormonal replacement. High doses of steroids are the first-line treatment of symptoms caused by mass effect in sella and compression of surrounding structures. In steroid-resistant patients or in cases of inacceptable sides effects, treatment with other immunosuppressant drugs was administered with success. The course of the disease varies: some patients present remission, in other cases hypophysitis leads to fibrosis and atrophy of the pituitary gland, which is reflected in persistent hormonal deficiencies and images of an empty sella. The objective of this article is to present the most important information: the epidemiology, clinical image, diagnostic procedures, and treatment of primary hypophysitis, in order to allow better understanding of this disease and implementation of proper management. Posttraumatic and immunotherapyrelated hypophysitis are also briefly characterised.

Abstract

Hypophysitis is a broad term used to describe conditions leading to inflammation of the pituitary gland and the pituitary stalk. It may develop as a primary condition or secondary to other diseases. Hypophysitis is classified based on aetiological, anatomical, and histological criteria. Clinical symptoms result from enlargement of the pituitary gland, hormonal deficiencies, diabetes insipidus, and hyperprolactinemia. Histopathological verification of tissue samples from a pituitary biopsy remains the gold standard in diagnosing hypophysitis. However, due to the invasiveness and risk of the procedure it is rarely performed. The diagnosis is based mainly on clinical presentation, laboratory tests, and imaging. The rarity of the disease and the deficit in reliable data result in a lack of clear guidelines in the treatment of hypophysitis. The basic therapy relies on hormonal replacement. High doses of steroids are the first-line treatment of symptoms caused by mass effect in sella and compression of surrounding structures. In steroid-resistant patients or in cases of inacceptable sides effects, treatment with other immunosuppressant drugs was administered with success. The course of the disease varies: some patients present remission, in other cases hypophysitis leads to fibrosis and atrophy of the pituitary gland, which is reflected in persistent hormonal deficiencies and images of an empty sella. The objective of this article is to present the most important information: the epidemiology, clinical image, diagnostic procedures, and treatment of primary hypophysitis, in order to allow better understanding of this disease and implementation of proper management. Posttraumatic and immunotherapyrelated hypophysitis are also briefly characterised.

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Keywords

hypophysitis; pituitary insufficiency; hypopituitarism; diabetes insipidus; pituitary stalk lesion

About this article
Title

Hypophysitis — new insights into diagnosis and treatment

Journal

Endokrynologia Polska

Issue

Vol 70, No 3 (2019)

Article type

Review paper

Pages

260-269

Published online

2019-06-30

Page views

5141

Article views/downloads

3015

DOI

10.5603/EP.a2019.0015

Pubmed

31290557

Bibliographic record

Endokrynol Pol 2019;70(3):260-269.

Keywords

hypophysitis
pituitary insufficiency
hypopituitarism
diabetes insipidus
pituitary stalk lesion

Authors

Łukasz Kluczyński
Aleksandra Gilis-Januszewska
Damian Rogoziński
Jacek Pantofliński
Alicja Hubalewska-Dydejczyk

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