Better Approaches to Diagnosing and Treating Hypophysitis

Hypophysitis is a rare, complex condition in which inflammation infiltrates the pituitary gland. It used to be considered a condition solely affecting peripartum women, but better diagnostics have identified this condition in other patients. Patients may experience tissue destruction, transient or permanent gland dysfunction, and endocrinopathies. A case review in a recent issue of the journal Pituitary looks at a series of patients diagnosed with and treated for hypophysitis over from 1997 to 2014.

The cases (N=21, 13 women and 8 men) were drawn from records at the University of California at San Francisco, and the researchers conducted retrospective analysis of patients with lymphocytic (n=16), granulomatous (n=3),IgG4-related (n=1) or lymphocytic-granulomatous hypophysitis (n=1). Only 3 cases occurred in peripartum periods. The researchers examined potential links between outcomes and endocrine function, radiographic appearance and disease recurrence.

Patients’ symptomatology varied, with most symptoms reflecting expanding sellar mass. Some symptoms were quite prevalent, with 48% to 57% of patients reporting headache, polyuria/polydipsia, vision changes, and amenorrhea or decreased libido.

Pre-treatment endocrine evaluation revealed that 57% of patients had complete anterior hypopituitarism, 52% of patients had diabetes insipidus, 48% had mild hyperprolactinemia, and 14% had isolated endocrine axis deficiencies with partial gland function.

All patients were treated with steroids and hormone supplementation as needed. Clinicians had ordered post-treatment MRI scans for 76% of patients, revealing radiographic improvement in half of scanned patients, and stable or worsened disease in the other half. Only female gender was associated with improved odds of post-steroid radiographic improvement.

Seventy-one percent of patients had post-treatment endocrine evaluations. Four

patients had some improvement in at least one axis, 7 had stable but non-worsened endocrine function, and 4 had worsened endocrine function post-steroids.

With increasing recognition of hypophysitis in patients outside the peripartum period, endocrinologists can benefit from review of its radiographic and clinical features. The authors note that surgical biopsy can be helpful to make definitive diagnosis and may guide treatment decision-making.