Clinical Features, Magnetic Resonance Imaging, and Treatment Experience of 20 Patients with Lymphocytic Hypophysitis in a Single Center

Lymphocytic hypophysitis (LYH) is a rare autoimmune inflammatory disease of the pituitary gland. In this study, we aim to characterize LYH at presentation and focus on the management and prognosis of LYH. A retrospective study of patients with LYH was conducted between 2011 and 2018 at a single inst...

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Bibliographic Details
Published in:World neurosurgery Vol. 127; pp. e22 - e29
Main Authors: Zhu, Qiang, Qian, Ke, Jia, Guijun, Lv, Gang, Wang, Jisheng, Zhong, Liyong, Yu, Shuqing
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.07.2019
Subjects:
Adolescent
Adult
Autoimmune Hypophysitis - complications
Autoimmune Hypophysitis - diagnostic imaging
Autoimmune Hypophysitis - pathology
Autoimmune Hypophysitis - therapy
Combined Modality Therapy
Diabetes insipidus
Diabetes Insipidus - etiology
Diagnosis, Differential
Diplopia - etiology
Female
Follow-Up Studies
Glucocorticoids - therapeutic use
Hemianopsia - etiology
Hormone Replacement Therapy
Humans
Hypophysectomy - methods
Lymphocytic hypophysitis
Magnetic Resonance Imaging
Male
Methylprednisolone - therapeutic use
Middle Aged
Neuroimaging
Pituitary Diseases - etiology
Pituitary Hormones - blood
Pituitary Hormones - therapeutic use
Retrospective Studies
Stalk thickening
Steroid pulse therapy
Treatment Outcome
Young Adult
GH
DI
MRI
Diabetes insipidus
Lymphocytic hypophysitis
ACTH
TSH
Steroid pulse therapy
IGF
PA
Stalk thickening
APA
TSS
FSH
LYH
LH
ISSN:1878-8750, 1878-8769, 1878-8769
Online Access:Get full text
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Summary:Lymphocytic hypophysitis (LYH) is a rare autoimmune inflammatory disease of the pituitary gland. In this study, we aim to characterize LYH at presentation and focus on the management and prognosis of LYH. A retrospective study of patients with LYH was conducted between 2011 and 2018 at a single institute. The patients were included by pathologic conformation and strict exclusion criteria. Clinical profile, imaging, and management data were collected. Twenty patients with LYH (16 women and 4 men) were included. Ten patients were diagnosed histologically and the remaining 10 patients were confirmed clinically of exclusion criteria. The median age at diagnosis was 37 years (range, 16–58 years). Presenting symptoms were followed by polyuria/polydipsia (11, 55%), vision changes (10, 50%), headache (8, 40%), menstrual irregularities and amenorrhea (4, 20%), diplopia (1, 5%), or sexual dysfunction (1, 5%). Eight patients had partial anterior pituitary hormone dysfunction. The thyroid-stimulating hormone axis was most involved. Ten patients received transsphenoidal surgery, 5 patients experienced steroid pulse therapy, and observation was performed on 5 patients. Only 5 patients (25%) showed improvement of anterior pituitary dysfunction after initial management. Recovery of diabetes insipidus occurred in 2 patients (18%). The overall recurrence rate was 22.2%. Nonoperative treatment is a better option for most patients with LYH because it is effective and noninvasive. Surgery is recommended for definitive diagnosis, severe or rapid progression of neurologic impairment, and glucocorticoid insensitivity. Periodic follow-up is mandatory in a patient's long-term management.
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ISSN:1878-8750
1878-8769
1878-8769
DOI:10.1016/j.wneu.2019.01.250