Treatment of Lymphocytic Hypophysitis by High-Dose Methylprednisolone Pulse Therapy.

Yamagami, Keiko; Yoshioka, Katsunobu; Sakai, Haruna; Fukumoto, Mariko; Yamakita, Tetsuya; Hosoi, Masayuki; Ishii, Tomofusa; Satô, Toshihiko; Tanaka, Shiro; Fujii, Satoru

doi:10.2169/internalmedicine.42.168

Cited by 52 publications

(27 citation statements)

References 11 publications

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“…Satisfactory response to high-dose steroid therapy or anti-inflammatory and immunosuppressive (methotrexate,cyclosporine A, azathioprine) treatments have been widely reported [2,27,32,[38][39][40][41][42][43]. Conservative management with close clinical observation has also been advocated as the primary therapeutic option based on the disease's often benign and transient course and spontaneous remission may occur [44].…”

Section: Treatmentmentioning

confidence: 99%

Primary granulomatous hypophysitis: a case report and literature review

Zhang

Yue

et al. 2011

Endocr J

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Section: Treatmentmentioning

confidence: 99%

Primary granulomatous hypophysitis: a case report and literature review

Zhang

Yue

et al. 2011

Endocr J

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“…Her MRI revealed a pituitary mass with an extension into the suprasellar cistern, with intense and homogeneous enhancement after gadolinium. She was treated with high-dose methylprednisolone pulse therapy (64). Her visual disturbance dramatically ameliorated on the first day of treatment and MRI revealed marked mass reduction, whereas pituitary function completely recovered 6 months after therapy (64).…”

Section: Therapeutic Strategymentioning

confidence: 99%

Lymphocytic hypophysitis: a rare or underestimated disease?

Bellastella

Bizzarro²,

Coronella³

et al. 2003

Eur J Endocrinol

197

205

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Lymphocytic hypophysitis (LYH) is an uncommon autoimmune disease in which the pituitary gland is infiltrated by lymphocytes, plasma cells and macrophages and its function is usually impaired. It has to be suspected in pregnant women and in women with recent delivery presenting with hyperprolactinemia, headache, visual field alterations and changes of one or more pituitary hormone secretions with secondary impairment of related peripheral target glands, especially when associated with other autoimmune endocrine or non-endocrine disorders. It can also occur less frequently in prepubertal or post-menopausal women and in men. Headache, visual field impairment and more rarely diplopia are due to extrasellar pituitary enlargement with optic chiasma compression and/or to invasion of cavernous sinuses. Among the 'isolated' pituitary hormone deficiencies, ACTH deficit is usually the earliest and most frequent hormonal impairment and in rare cases can induce an acute secondary hyposurrenalism as the first sign of the disease, with high mortality in affected patients. Histopathological findings from pituitary biopsy show lymphoplasmacytic infiltrate with lymphoid aggregates surrounding atropic acini of pituitary cells; immunohistochemical analysis shows numerous mast cells randomly distributed and also localized in the vicinity of capillaries, suggesting a possible influence on capillary permeability and angiogenesis, thus favoring the inflammatory and immunological aggression against pituitary cells. Nuclear magnetic resonance imaging shows uniform sellar floor depression and an extrasellar symmetrical pituitary enlargement, usually displacing the optic chiasma, which shows a rapid homogeneous enhancement after gadolinium also involving the adjacent dura (dural tail). Antipituitary antibodies have been detected in several patients with LYH but their role needs to be clarified. Since a possible spontaneous remission can occur, a careful follow-up is required in subclinical patients without important hyposurrenalism or symptomatic extrasellar expansion. Medical (immunosuppressive, replacement and antiprolactinemic) and neurosurgical (decompression) treatments are needed in clinical symptomatic patients.

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“…Satisfactory responses to high-dose steroid therapy and administration of methotrexate have been reported (2,13,39,40,44). Spontaneous resolution of the lesion on MRI following steroid therapy has been described, but endocrine improvement is rare (21).…”

Section: Patientmentioning

confidence: 99%

Primary non-necrotizing granulomatous hypophysitis mimicking pituitary adenomas

Yıldırım¹,

Divanlıoğlu²,

Çetinalp³

et al. 2014

Turkish Neurosurgery

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AIm:The authors review their experience in the endoscopic endonasal transsphenoidal treatment of 5 patients, finally diagnosed as primary hypophysitis but initially assumed to be pituitary adenomas. mATERIAL and mETHods: A retrospective study was undertaken to review 5 cases of primary non-necrotizing granulomatous hypophysitis (1.61%) through 310 endoscopic transsphenoidally operated cases with the diagnosis of pituitary adenoma between 2009 and 2013. All 5 cases were female without any background of autoimmunity or recent pregnancy. The initial presumptive diagnosis was pituitary adenoma for all patients. The endocrinological diagnoses of the patients were suspected Cushing's Disease, anterior pituitary deficiency with hyponatremia, hyperprolactinemia, and acromegaly. One of the patients had normal hormonal levels. All patients had macroadenomas including one invasive adenoma with skull base involvement. One of the patients (20%) had visual field defects. All patients underwent endoscopic endonasal transsphenoidal surgery (EETS). REsuLTs:All patients had improvement of hormonal levels postoperatively except the one with anterior pituitary deficiency who required long term hormone replacement after the surgery. Mean follow-up duration was 14.8 months.CoNCLusIoN: Primary granulomatous hypophysitis without any known etiological factors is very rare in the literature. It can mimic pituitary adenomas in radiological and endocrinological aspects. EETS is an effective and safe treatment especially for visual and compression symptoms.KEywoRds: Primary hypophysitis, Non-necrotizing, Granulomatous, Endoscopic, Secretory adenoma ÖZ AmAÇ: Hipofiz adenomu ön tanısı ile endoskopik endonazal transsfenoidal (EETS) yöntemle tedavi edilen ve patoloji tanısı primer hipofizit olan 5 olguluk deneyim sunulmaktadır. yÖNTEm ve GEREÇLER: Çalışmada 2009 ile 2013 yılları arasında endoskopik endonazal yolla opere edilen 310 hipofiz adenomu olgusu içerisinden patoloji tanısı primer nonnekrotizan granulomatöz hipofizit olan 5 olgu (%1,61) geriye dönük olarak incelendi. Hastaların hepsi kadın cinsiyette olup, hiçbirinde gebelik ya da altta yatan otoimmün hastalık gibi bir neden yok idi. Tüm hastaların ön tanısı hipofiz adenomu idi. Hastalarda endokrinolojik olarak sırasıyla şüpheli Cushing Hastalığı, hiponatremi ile birlikte hipofizer yetmezlik, hiperprolaktinemi, normal hormonal tablo ve akromegali ile uyumlu laboratuvar değerleri saptandı. Bir tanesi kafa kaidesi tutulumu ile birlikte invaziv adenom olmak üzere tüm olgular makroadenomdu. Bir hastada görme alanı defisiti saptandı. Tüm hastalara EETS cerrahi uygulandı.BuLGuLAR: Preoperatif yetmezlik bulguları olan hasta hariç tüm hastalarda postoperatif normal hormonal değerler sağlandı.Hastalar ortalama 14,8 ay takip edildi.soNuÇ: Primer non-nekrotizan hipofizitler nedeni bilinmeyen ve nadir görülen hastalıklar olup radyolojik ve endokrinolojik olarak hipofiz adenomlarını taklit edebilirler. EETS yol ise görme ile ilgili ve bası semptomlarının kaldırılmasında güvenli ve etkili bir...

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Treatment of Lymphocytic Hypophysitis by High-Dose Methylprednisolone Pulse Therapy.

Cited by 52 publications

References 11 publications

Primary granulomatous hypophysitis: a case report and literature review

Primary granulomatous hypophysitis: a case report and literature review

Lymphocytic hypophysitis: a rare or underestimated disease?

Primary non-necrotizing granulomatous hypophysitis mimicking pituitary adenomas

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