Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis
Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable. To identify clinical and radiological findings associated with response to glucocorticoids. 12 consecutive patients with AH, evaluated from...
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| Vydané v: | European journal of endocrinology Ročník 177; číslo 2; s. 127 |
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| Hlavní autori: | , , , , , , , , , |
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| Jazyk: | English |
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01.08.2017
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| ISSN: | 1479-683X, 1479-683X |
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| Abstract | Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable.
To identify clinical and radiological findings associated with response to glucocorticoids.
12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12-96 months).
MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (
= 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (
= 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28%
= 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%;
= 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (
= 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (
= 0.008) but diabetes insipidus persisted in all.
Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids. |
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| AbstractList | Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable.
To identify clinical and radiological findings associated with response to glucocorticoids.
12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12-96 months).
MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (
= 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (
= 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28%
= 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%;
= 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (
= 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (
= 0.008) but diabetes insipidus persisted in all.
Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids. Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable.INTRODUCTIONAutoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable.To identify clinical and radiological findings associated with response to glucocorticoids.OBJECTIVETo identify clinical and radiological findings associated with response to glucocorticoids.12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12-96 months).DESIGN AND METHODS12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12-96 months).MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (n = 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (n = 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28% P = 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%; P = 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (P = 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (P = 0.008) but diabetes insipidus persisted in all.RESULTSMRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (n = 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (n = 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28% P = 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%; P = 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (P = 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (P = 0.008) but diabetes insipidus persisted in all.Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids.CONCLUSIONSGlucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids. |
| Author | Martino, Enio Caturegli, Patrizio Lupi, Isabella Manetti, Luca Marcocci, Claudio Bogazzi, Fausto Scattina, Ilaria Cosottini, Mirco Urbani, Claudio Cappellani, Daniele |
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| SubjectTerms | Adult Aged Autoimmune Hypophysitis - blood Autoimmune Hypophysitis - diagnostic imaging Autoimmune Hypophysitis - drug therapy Cohort Studies Diabetes Insipidus - blood Diabetes Insipidus - diagnostic imaging Diabetes Insipidus - drug therapy Female Follow-Up Studies Glucocorticoids - therapeutic use Humans Magnetic Resonance Imaging - methods Male Middle Aged Prognosis Retrospective Studies Treatment Outcome |
| Title | Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis |
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