Corticosteroids in the management of lymphocytic hypophysitis: Case series

Background: The diagnosis of lymphocytic hypophysitis (LYH) is a clinical challenge. Medical management with steroids may result in complete resolution of the symptoms and radiological features. We report our approach to the diagnosis and treatment of LYH. Materials and Methods: Retrospective analys...

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Vydáno v:	Neurology India Ročník 66; číslo 2; s. 400 - 404
Hlavní autoři:	Panigrahi, Manas, Kumari, Manoranjitha, Vooturi, Sudhindra
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	India Wolters Kluwer India Pvt. Ltd 01.03.2018 Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd
Témata:	Adrenal Cortex Hormones - therapeutic use Adult Autoimmune diseases Autoimmune Hypophysitis - diagnostic imaging Autoimmune Hypophysitis - drug therapy Autoimmune Hypophysitis - surgery Corticosteroid drugs Diagnosis Disease Management Dosage and administration Excision (Surgery) Female Histopathology Humans India Laboratories Magnetic Resonance Imaging Male Medical diagnosis Middle Aged Neurosurgery Neurosurgical Procedures - methods NMR Nuclear magnetic resonance Patients Pituitary gland Retrospective Studies Steroids Surgery Thyroid gland Tumors Young Adult India Corticosteroids lymphocytic hypophysitis surgical resection Key Message: Lymphocytic hypophysitis may present with the characteristic magnetic resonance imaging features of stalk involvement and a homogenous enhancement of the lesion after contrast administration. Medical management by using steroids may play an equally important role as the surgical management. A patient suffering from an autoimmune disease who presents with a sellar lesion should be suspected of having lymphocytic hypophysitis. Surgical resection is often advocated when optic nerve and/or chiasmal compression is detected and for lesions nonresponsive to medical management the presence of a normal sella with the stalk in the midline the presence of a dural tail outcome absent T1 bright spot surgical resection
ISSN:	0028-3886, 1998-4022
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Shrnutí:	Background: The diagnosis of lymphocytic hypophysitis (LYH) is a clinical challenge. Medical management with steroids may result in complete resolution of the symptoms and radiological features. We report our approach to the diagnosis and treatment of LYH. Materials and Methods: Retrospective analysis of data of nine consecutive patients of LYH from August 2013 to August 2015 was done. The average age of the study population was 38.4 ± 19.8 years, with five (55.5%) women. Presumptive diagnosis of LYH was made in six patients who were treated with steroids. Among the medical intervention group, one patient developed progressive ocular symptoms involving the third cranial nerve, which required surgical intervention. Out of the five remaining patients under medical treatment, four patients showed improvement in clinical symptoms and resolution of radiological features and one patient showed recurrence of the lesion. In the surgical group, the diagnosis was made after the histopathological confirmation. Results: In the surgical group, the diagnosis was made after the histopathological confirmation in all patients except one. All the patients in this group presented with optic nerve compression requiring surgical decompression. All the patients in this group showed symptomatic improvement postoperatively. Symptoms for deficiency of hormones required supplementation dose of steroids. Conclusion: Steroids should be considered as the first line of management in LYH. Surgical resection should be considered in the presence of optic nerve and/or chiasmal compression and for lesions nonresponsive to medical management.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0028-3886 1998-4022
DOI:	10.4103/0028-3886.227293