An Overview of Diagnosis of Primary Autoimmune Hypophysitis in a Prospective Single-Center Experience

Chiloiro, Sabrina; Tartaglione, Tommaso; Angelini, Flavia; Bianchi, Antonio; Arena, Vincenzo; Giampietro, Antonella; Mormando, Marilda; Sciandra, Mariacarmela; Laino, Maria Elena; Marinis, Laura De

doi:10.1159/000446544

Cited by 42 publications

(44 citation statements)

References 33 publications

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“…On some occasions, in cases of primary hormonal deficiency (such as primary hypothyroidism, primary hypoadrenalism and primary hypogonadism), a compensatory pituitary hypertrophy occurs (20). At least, also in hypophysitis, which represents an emerging and more frequently diagnosed disease (34), pituitary hyperplasia could evolve in empty sella, as last stage of disease, as suggested by the presence of antipituitary antibodies in around 6% of PES cases (35).…”

Section: Pituitary Factorsmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

Chiloiro¹,

Giampietro²,

Bianchi³

et al. 2017

European Journal of Endocrinology

120

149

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Primary empty sella (PES) is characterized by the herniation of the subarachnoid space within the sella, which is often associated with variable degrees of flattening of the pituitary gland in patients without previous pituitary pathologies. PES pathogenetic mechanisms are not well known but seem to be due to a sellar diaphragm incompetence, associated to the occurrence of upper sellar or pituitary factors, as intracranial hypertension and change of pituitary volume. As PES represents in a majority of cases, a neuroradiological findings without any clinical implication, the occurrence of endocrine, neurological and opthalmological symptoms, due to the above describes anatomical alteration, which delineates from the so called PES syndrome. Headache, irregular menses, overweight/obesity and visual disturbances compose the typical picture of PES syndrome and can be the manifestation of an intracranial hypertension, often associated with PES. Although hyperprolactinemia and growth hormone deficit represent the most common endocrine abnormalities, PES syndrome is characterized by heterogeneity both in clinical manifestation and hormonal alterations and can sometime reach severe extremes, as occurrence of papilledema, cerebrospinal fluid rhinorrhea and worsening of visual acuity. Consequently, a multidisciplinary approach, with the integration of endocrine, neurologic and ophthalmologic expertise, is strongly advocated and recommended for a properly diagnosis, management, treatment and follow-up of PES syndrome and all of the related abnormalities.

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Section: Pituitary Factorsmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

Chiloiro¹,

Giampietro²,

Bianchi³

et al. 2017

European Journal of Endocrinology

120

149

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show abstract

“…The recognition of infectious/inflammatory diseases as the important causes of hypopituitarism has increased in the recent years [23]. Pituitary abscesses and the infection of the central nervous system of various etiologies, tuberculosis-TBC, and other bacterial, viral, and fungal infections can affect hypothalamo/pituitary axis and disrupt its function [24, 25].…”

Section: Introductionmentioning

confidence: 99%

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

Doknic

Pekić

Miljić

et al. 2017

International Journal of Endocrinology

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There are only a few published studies related to the population-based etiology of hypopituitarism. New risks for developing hypopituitarism have been recognized in the last 10 years. Aim. To present data regarding the etiology of hypopituitarism collected in a tertiary center over the last decade. This is a cross-sectional database study. Patients and Methods. We included 512 patients (pts) with hypopituitarism, with a mean age of 45.9 ± 1.7 yrs (range: 18–82; male: 57.9%). Results. Nonfunctional pituitary adenomas were presented in 205 pts (40.5%), congenital causes in 74 pts (14.6%), while acromegaly and prolactinomas were presented in 37 (7.2%) and 36 (7.0%) patients, respectively. Craniopharyngiomas were detected in 30 pts (5.9%), and head trauma due to trauma brain injury-TBI and subarachnoid hemorrhage-SAH in 27 pts (5.4%). Survivors of hemorrhagic fever with renal syndrome (HFRS) and those with previous cranial irradiation were presented in the same frequency (18 pts, 3.5% each). Conclusion. The most common causes of hypopituitarism in our database are pituitary adenomas. Increased awareness of the other causes of pituitary dysfunction, such as congenital, head trauma, extrapituitary cranial irradiation, and infections, is the reason for a higher frequency of these etiologies of hypopituitarism in the presented database.

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“…According to clinical and neuroradiological findings, hypophysitis can involve the anterior pituitary gland, infundibulum, posterior lobe (infundibuloneurohypophysitis) or the entire pituitary gland (panhypophysitis) (13). Infundibuloneurohypophysitis is related to the etiological diagnosis of anterior hypopituitarism, particularly GH deficit, and secondary hypogonadism and DI (14). In other studies, it was reported that primary hypophysitis was usually seen in the anterior lobe of hypophysitis (15), and symptoms due to anterior pituitary hormone deficiency were the highest (16).…”

Section: Discussionmentioning

confidence: 99%

Clinical and hormonal characteristics of patients with different types of hypophysitis: a single-center experience

Imga¹,

Yıldırım²,

Baser³

et al. 2019

Archives of Endocrinology and Metabolism

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Objective: The inflammation of the pituitary gland is known as hypophysitis. It is a rare disease accounting for approximately 0.24%-0.88% of all pituitary diseases. The natural course of hypophysitis is variable. Main forms are histologically classified as lymphocytic, granulomatous, IgG4 related and xanthomatous. We aim to present our patients with hypophysitis and compare clinical, laboratory and radiological features. Subjects and methods: We retrospectively reviewed our database of 1.293 patients diagnosed with pituitary diseases between 2010 and 2017. Twelve patients with hypophysitis were identified. Demographical data, clinical features, endocrinological dysfunction, imaging findings, treatment courses and follow-up periods were evaluated. Results: The frequency of hypophysitis was found 0.93% in all cases of the pituitary disease. Twelve patients (nine females and three males), ages between 17-61 years, were evaluated. The characteristic features of our patients tended to be predominantly female and young. Diagnosis of hypophysitis was made after pituitary biopsy in four patients, and in eight patients after pituitary operation due to adenoma. Headache (67%) and visual problems (33%) were the most frequent nonendocrine symptoms. Anterior pituitary hormone deficiencies (63.7%) and/or diabetes insipidus (17%) were seen among patients. According to histopathological forms, four had lymphocytic, seven had granulomatous and one had xanthogranulomatous types. Contrast enhancement heterogeneous and thickened pituitary stalk were the most common radiological alterations. Conclusion: Hypophysitis should be considered in the differential diagnosis of sellar masses. It can mimic pituitary adenomas in radiological and endocrinological aspects. The different patterns of pituitary hormone deficiencies may be seen in the course of the disease.

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An Overview of Diagnosis of Primary Autoimmune Hypophysitis in a Prospective Single-Center Experience

Cited by 42 publications

References 33 publications

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

Clinical and hormonal characteristics of patients with different types of hypophysitis: a single-center experience

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