Postpartum headache: A broader differential

Nikouline, Anton; Carr, David

doi:10.1016/j.ajem.2020.07.022

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…Endocrine symptoms or neurological symptoms due to mass effect are common [ 20 ]. These include headache, nausea, visual disturbances, diplopia, cranial nerve 3, 4, and 6 neuropathies, hydrocephalus, and mental status changes [ 11 , 46 ]. Carotid artery occlusion and symptoms that mimic meningitis or pituitary apoplexy are consequences of extensive mass effect [ 2 , 14 , 46 ].…”

Section: Diagnosismentioning

confidence: 99%

“…Hypopituitarism and central DI are the most clinically significant problems and require immediate attention [ 7 ]. Lymphocytic hypophysitis has a predilection to dysregulate ACTH, gonadotrophins, TSH, then growth hormone, in that sequence, and isolated hormone deficits are rare [ 2 , 46 ]. This is contrary to other causes of hypopituitarism, where impaired initial ACTH or TSH secretion is uncommon.…”

Section: Diagnosismentioning

confidence: 99%

“…Subacute onset of symptoms is seen in young women who are towards the end of pregnancy or recently postpartum. In pregnant women, the differential diagnosis for headaches includes pre-eclampsia, post-dural puncture headache, central venous sinus thrombosis, and Sheehan syndrome [ 14 , 46 ]. Hypophysitis is an important consideration.…”

Section: Diagnosismentioning

confidence: 99%

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Hypophysitis: Defining Histopathologic Variants and a Review of Emerging Clinical Causative Entities

Rawanduzy

Winkler-Schwartz

Couldwell

2023

IJMS

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Inflammatory disease of the pituitary gland is known as hypophysitis. There are multiple histological subtypes, the most common being lymphocytic, and the pathogenesis is variable and diverse. Hypophysitis can be primary and idiopathic or autoimmune related, or secondary to local lesions, systemic disease, medications, and more. Although hypophysitis was previously accepted as an exceedingly rare diagnosis, a greater understanding of the disease process and new insights into possible etiologic sources have contributed to an increased frequency of recognition. This review provides an overview of hypophysitis, its causes, and detection strategies and management.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Hypophysitis: Defining Histopathologic Variants and a Review of Emerging Clinical Causative Entities

Rawanduzy

Winkler-Schwartz

Couldwell

2023

IJMS

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“…In late disease stages, the pituitary gland may appear atrophic, and MRI may show sellar arachnoidocele or an empty sella ( 47 , 48 ). Although there are no definite MRI features that can confirm hypophysitis, imaging can be diagnostic in the right clinical context; for example, stalk thickening in a young woman with recent pregnancy presenting with headache and hypopituitarism is highly suggestive of LHy ( 49 ). Specific radiologic findings in different types of hypophysitis are presented in Figure 1 .…”

Section: What Are the Radiological Features Of Hypophysitis?mentioning

confidence: 99%

Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease

Langlois

Varlamov

Fleseriu

2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Hypophysitis is defined as inflammation of the pituitary gland that is primary or secondary to a local or systemic process. Differential diagnosis is broad (including primary tumors, metastases, and lympho-proliferative diseases) and multifaceted. Patients with hypophysitis typically present with headaches, some degree of anterior and/or posterior pituitary dysfunction, and enlargement of pituitary gland and/or stalk, as determined by imaging. Most hypophysitis causes are autoimmune, but other etiologies include inflammation secondary to cellar tumors or cysts, systemic diseases, and infection or drug-induced causes. Novel pathologies such as IgG4-related hypophysitis, immunotherapy-induced hypophysitis and paraneoplastic pituitary-directed autoimmunity are also included in a growing spectrum of this rare pituitary disease. Typical magnetic resonance imaging reveals stalk thickening and homogenous enlargement of the pituitary gland, however, imaging is not always specific. Diagnosis can be challenging and ultimately, only a pituitary biopsy can confirm hypophysitis type and rule out other etiologies. A presumptive diagnosis can be made often without biopsy. Detailed history and clinical examination are essential, notably for signs of underlying etiology with systemic manifestations. Hormone replacement and in selected cases careful observation is advised with imaging follow-up. High-dose glucocorticoids are initiated mainly to help reduce mass effect. A response may be observed in all auto-immune etiologies, but also in lymphoproliferative diseases, and as such should not be used for differential diagnosis. Surgery may be necessary in some cases to relieve mass effect and allow a definite diagnosis. Immunosuppressive therapy and radiation are sometimes also necessary in resistant cases.

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Pregnancy-related hypophysitis revisited

Honegger

Giese

Nasi‐Kordhishti

et al. 2023

European Journal of Endocrinology

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Objective The aim of the study is to assess the distinguishing features of pregnancy-related hypophysitis (PR-Hy) compared to non-pregnancy autoimmune hypophysitis and to evaluate the changing therapeutic approaches and outcome in PR-Hy over time. Design Retrospective analysis of all published cases with PR-Hy and six own cases. Methods A PubMed search was performed and abstracts screened for publications with information on cases with PR-Hy from which full-text review was performed. Clinical features, diagnostic findings, and outcome in relation to treatment modalities in PR-Hy were assessed. Results One hundred and forty eight cases with PR-Hy were identified. PR-Hy was significantly delimited from non-PR-Hy by frequent occurrence of chiasmal syndrome (50% vs 13%, P < 0.0001), higher rate of intrasellar origin (94% vs 74%, P = 0.0005), lower rate of pituitary stalk involvement (39% vs 86%, P < 0.0001), and low rate of diabetes insipidus (12% vs 54%, P < 0.0001). The role of surgery in PR-Hy decreased over time while noninvasive treatment modalities increased. The recurrence rate after high-dose glucocorticoid therapy (36%) was high and exceeded that of surgery (2%) and conservative management (3%). In contrast to initial reports on PR-Hy, recent literature regarding outcome of mother’s and child’s health was positive. The frequency of spontaneous preterm delivery was not increased. Recurrent PR-Hy in a subsequent pregnancy was reported in only 2 females. Conclusion PR-Hy has distinct features that delineate the disorder from non-PR-Hy. With increasing experience in diagnosis, availability of adequate replacement therapy, and improved treatment modalities, PR-Hy has lost its threat and the outcome is encouraging.

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Postpartum headache: A broader differential

Cited by 4 publications

References 6 publications

Hypophysitis: Defining Histopathologic Variants and a Review of Emerging Clinical Causative Entities

Hypophysitis: Defining Histopathologic Variants and a Review of Emerging Clinical Causative Entities

Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease

Pregnancy-related hypophysitis revisited

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