Primary lymphocytic hypophysitis: Clinical characteristics and treatment of 50 cases in a single centre in China over 18 years

Summary Objective Primary lymphocytic hypophysitis (LYH) is rare, and it is often evaluated in a small case series. This study aimed to describe the diagnosis and treatment of primary LYH in a larger cohort. Design A retrospective study of the diagnosis and treatment of primary LYH was conducted at...

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Veröffentlicht in:Clinical endocrinology (Oxford) Jg. 87; H. 2; S. 177 - 184
Hauptverfasser: Wang, Shuchang, Wang, Linjie, Yao, Yong, Feng, Feng, Yang, Hongbo, Liang, Zhiyong, Deng, Kan, You, Hui, Sun, Jian, Xing, Bing, Jin, Zimeng, Wang, Renzhi, Pan, Hui, Zhu, Huijuan
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Wiley Subscription Services, Inc 01.08.2017
Schlagworte:
Adrenal Insufficiency - complications
Adrenocorticotropic hormone
Autoimmune Hypophysitis - diagnosis
Autoimmune Hypophysitis - diagnostic imaging
Autoimmune Hypophysitis - drug therapy
China
Diabetes insipidus
Diabetes Insipidus, Neurogenic - complications
Follicle-stimulating hormone
Glucocorticoids
Glucocorticoids - therapeutic use
Hypogonadism
Hypogonadism - complications
Insulin-like growth factor I
Insulin-Like Growth Factor I - deficiency
Logistic Models
Luteinizing hormone
lymphocytic hypophysitis
Magnetic Resonance Imaging
Medical diagnosis
Pituitary (anterior)
Pituitary Gland - pathology
Pituitary Hormones, Anterior - deficiency
Retrospective Studies
surgery
treatment
treatment
glucocorticoids
lymphocytic hypophysitis
surgery
ISSN:0300-0664, 1365-2265, 1365-2265
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Zusammenfassung:Summary Objective Primary lymphocytic hypophysitis (LYH) is rare, and it is often evaluated in a small case series. This study aimed to describe the diagnosis and treatment of primary LYH in a larger cohort. Design A retrospective study of the diagnosis and treatment of primary LYH was conducted at Peking Union Medical College Hospital from 1999 to 2016. Patients Fifty patients (28 histologically diagnosed and 22 clinically‐diagnosed) were eligible for inclusion. Measurements Clinical, endocrine, pathological and imaging findings; therapies and outcomes were assessed. Ordinal logistic regression analysis was used to evaluate the association between the clinical parameters and outcomes (eg, improvements in pituitary function, regression of lesion size on MRI and disease recurrence). Results Central diabetes insipidus (CDI) (72.0%) was the most common endocrine dysfunction. Hypogonadotropic hypogonadism was the most frequently observed (60.0%) manifestation of anterior pituitary dysfunction; adrenal insufficiency was the third most common (26.0%) manifestation; and IGF‐1 axis defects were the least frequent (22.0%). Thickening of the pituitary stalk was the most frequent (96.0%) imaging finding, and 78.0% of the patients exhibited both intrasellar and suprasellar expansion. Pharmacological dose of glucocorticoids was identified to be significantly associated with increased odds of anterior pituitary function improvement. No observed covariates were significantly associated with improvement of CDI and recurrence. Conclusion The sequence of anterior pituitary deficiencies in Chinese primary LYH patients was atypical (LH/FSH>TSH>ACTH>IGF‐1 axis deficiency). A pharmacological dose of glucocorticoids was significantly associated with the improved anterior pituitary insufficiency.
Bibliographie:Funding information
This study was supported by a grant from the National Key Program of Clinical Science (National Health Family Planning Commission), China (WBYZ2011‐873).
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ISSN:0300-0664
1365-2265
1365-2265
DOI:10.1111/cen.13354