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Vnitrni Lekarstvi 2022Enlargement of the pituitary gland is heterogenous in the etiology. Common causes of pituitary enlargement are physiological hypertrophy during pregnancy, primary and...
Enlargement of the pituitary gland is heterogenous in the etiology. Common causes of pituitary enlargement are physiological hypertrophy during pregnancy, primary and secondary tumors, autoimmune hypophysitis including side effects of anticancer therapy with check-point inhibitors. Terms like hypertrophy, hyperplasia, sellar expansion and hypophysitis are commonly used to describe enlargement of the pituitary gland on MR scan regardless its etiology. The most common pathology causing pituitary gland enlargement is pituitary adenoma. Magnetic resonance imaging can differentiate pituitary tumors from diffuse enlargement due to hypophysitis in most but not all cases. Changes on imaging during time or response to pharmacotherapy might help determine the final diagnosis in uncertain cases. We present a case report of a young woman with sellar expansion due to prolonged untreated peripheral hypothyroidism mimicking pituitary adenoma. Interdisciplinary cooperation of endocrinologist, radiologist and neurosurgeon is crucial in determining the diagnosis.
Topics: Adenoma; Diagnosis, Differential; Female; Humans; Hypertrophy; Hypophysitis; Hypothyroidism; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Pregnancy
PubMed: 35459348
DOI: No ID Found -
AJNR. American Journal of Neuroradiology Sep 2022Granulomatous hypophysitis is a rare inflammatory condition of the pituitary gland with an imaging appearance that can overlap with that of pituitary adenoma.... (Review)
Review
BACKGROUND AND PURPOSE
Granulomatous hypophysitis is a rare inflammatory condition of the pituitary gland with an imaging appearance that can overlap with that of pituitary adenoma. Differentiating the two before surgical resection can have important treatment implications. The purpose of our study was to determine whether it was possible to differentiate between granulomatous hypophysitis and pituitary adenoma on the basis of diffuse enhancing infrasellar basisphenoid bone marrow.
MATERIALS AND METHODS
We present 3 cases, initially thought to be pituitary adenomas, that were pathology-proved granulomatous hypophysitis. The preoperative MR images were reviewed for diffuse, enhancing infrasellar basisphenoid bone marrow. For comparison, we reviewed 100 cases of pathology-proved pituitary adenoma for the same finding. Additionally, imaging findings including the sphenoid sinus pneumatization pattern, clinical history, laboratory values, and pathology results were reviewed.
RESULTS
All 3 cases of granulomatous hypophysitis had diffuse enhancing infrasellar basisphenoid bone marrow. Conversely, this was not seen in any of the 100 pituitary adenomas. The patients with granulomatous hypophysitis were all women. Two patients had idiopathic granulomatous hypophysitis, and 1 had secondary granulomatous hypophysitis with sarcoidosis. Of the 100 patients with pituitary adenomas, 67 were women. The basisphenoid pneumatization patterns was as follows: 15 (type 2), 40 (type 3), and 45 (type 4).
CONCLUSIONS
We present 3 cases of granulomatous hypophysitis with diffuse enhancement of the infrasellar basisphenoid bone marrow that was not seen in our 100 cases of pituitary adenomas. This imaging feature may be valuable for suggesting a diagnosis of granulomatous hypophysitis and avoiding surgical resection of what might otherwise be misdiagnosed as a pituitary adenoma.
Topics: Humans; Female; Male; Pituitary Neoplasms; Diagnosis, Differential; Hypophysitis; Pituitary Gland; Autoimmune Hypophysitis; Magnetic Resonance Imaging
PubMed: 36007945
DOI: 10.3174/ajnr.A7618 -
Indian Pediatrics Jan 2021
Topics: Autoimmune Hypophysitis; Humans; Lupus Erythematosus, Systemic
PubMed: 33452786
DOI: No ID Found -
Revista Espanola de Patologia :... 2022Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous...
Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous hypophysitis is an inflammatory disease condition which accounts for less than 1% of all cellular lesions and can mimic adenoma. A 32-year-old woman presented with weight gain, galactorrhea and blurred vision. The MRI showed a cystic, nodular lesion in the intermediate lobe of the pituitary gland and the initial diagnosis was adenoma. She underwent surgery and the histopathology revealed granulomas composed of epithelioid histiocytes, multinuclear giant cells and mononuclear inflammatory cells. Inflammatory diseases of the pituitary gland are much less frequent than pituitary adenomas and idiopathic granulomatous hypophysitis is extremely rare. Histopathology and the ruling out of a systemic cause are the gold standards for its diagnosis.
Topics: Adenoma; Adult; Autoimmune Hypophysitis; Female; Galactorrhea; Humans; Hypophysitis; Pituitary Neoplasms; Pregnancy
PubMed: 35779888
DOI: 10.1016/j.patol.2019.11.005 -
Pituitary Feb 2022Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of...
OBJECTIVE
Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of immunotherapy-induced hypophysitis (IIH) and primary hypophysitis (PH) DESIGN: Retrospective multicenter cohort study including 56 patients with IIH and 60 patients with PH.
METHODS
All patients underwent extensive endocrine testing. Data on age, gender, symptoms, endocrine dysfunction, MRI, immunotherapeutic agents and autoimmune diseases were collected.
RESULTS
Median time of follow-up was 18 months in IIH and 69 months in PH. The median time from initiation of immunotherapy to IIH diagnosis was 3 months. IIH affected males more frequently than PH (p < 0.001) and led to more impaired pituitary axes in males (p < 0.001). The distribution of deficient adenohypophysial axes was comparable between both entities, however, central hypocortisolism was more frequent (p < 0.001) and diabetes insipidus considerably less frequent in IIH (p < 0.001). Symptoms were similar except that visual impairment occurred more rarely in IIH (p < 0.001). 20 % of IIH patients reported no symptoms at all. Regarding MRI, pituitary stalk thickening was less frequent in IIH (p = 0.009). Concomitant autoimmune diseases were more prevalent in PH patients before the diagnosis of hypophysitis (p = 0.003) and more frequent in IIH during follow-up (p = 0.002).
CONCLUSIONS
Clinically, IIH and PH present with similar symptoms. Diabetes insipidus very rarely occurs in IIH. Central hypocortisolism, in contrast, is a typical feature of IIH. Preexisting autoimmunity seems not to be indicative of developing IIH.
Topics: Cohort Studies; Humans; Hypophysitis; Immunotherapy; Ipilimumab; Male; Retrospective Studies
PubMed: 34518996
DOI: 10.1007/s11102-021-01182-z -
International Journal of Molecular... Mar 2023With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such... (Review)
Review
With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such malignancies often interfere with RA treatment. Among several therapeutic agents, immune checkpoint inhibitors (ICIs) which antagonize immunological brakes on T lymphocytes have emerged as a promising treatment option for a variety of malignancies. In parallel, evidence has accumulated that ICIs are associated with numerous immune-related adverse events (irAEs), such as hypophysitis, myocarditis, pneumonitis, and colitis. Moreover, ICIs not only exacerbate pre-existing autoimmune diseases, but also cause de novo rheumatic disease-like symptoms, such as arthritis, myositis, and vasculitis, which are currently termed rheumatic irAEs. Rheumatic irAEs differ from classical rheumatic diseases in multiple aspects, and treatment should be individualized based on the severity. Close collaboration with oncologists is critical for preventing irreversible organ damage. This review summarizes the current evidence regarding the mechanisms and management of rheumatic irAEs with focus on arthritis, myositis, and vasculitis. Based on these findings, potential therapeutic strategies against rheumatic irAEs are discussed.
Topics: Humans; Aged; Immune Checkpoint Inhibitors; Rheumatic Diseases; Arthritis, Rheumatoid; Neoplasms; Myositis; Vasculitis
PubMed: 36982715
DOI: 10.3390/ijms24065643 -
Best Practice & Research. Clinical... May 2022
Topics: Autoimmunity; Endocrine System Diseases; Humans; Hypophysitis; Neoplasms
PubMed: 35577694
DOI: 10.1016/j.beem.2022.101666 -
Acta Neurochirurgica Aug 2022IgG4-related hypophysitis (IgG4-RH) is a rare chronic inflammatory condition of the pituitary gland. This study reports the presentation, management and outcomes for...
PURPOSE
IgG4-related hypophysitis (IgG4-RH) is a rare chronic inflammatory condition of the pituitary gland. This study reports the presentation, management and outcomes for patients with histologically proven IgG4-related hypophysitis.
METHODS
A prospectively maintained electronic database was searched over a 14-year period from 1 January 2007 to 31 December 2020 at a single academic centre to identify all patients with a histological diagnosis of IgG4-RH. A retrospective case note review from electronic health records was conducted for each case to extract data on their presentation, management and outcomes.
RESULTS
A total of 8 patients (5 male) with a median age of 51 years were identified. The most common presenting symptoms were headache (4/8; 50%), fatigue (3/8; 37.5%) and visual impairment (2/8; 25%). Three patients were initially treated with high-dose steroids aiming for reduction of the pituitary mass. However, ultimately all patients underwent transsphenoidal surgery. Post-operative changes included radiological reduction in pituitary mass in all patients that had imaging (7/7; 100%), improvement in vision (1/2; 50%), residual thick pituitary stalk (5/7; 71.4%), persistent anterior hypopituitarism (4/8; 50%) and panhypopopituitarism including diabetes insipidus (3/8; 37.5%).
CONCLUSIONS
IgG4-RH is an increasingly recognised entity presenting with a variety of symptoms and signs. Clinical presentation is similar to other forms of hypophysitis. It is therefore important to consider IgG4-RH as a differential and to have a low threshold for pituitary biopsy, the diagnostic gold standard. The diagnosis of IgG4-RH will guide decisions for additional workup for IgG4-related disease, multi-disciplinary team involvement and follow-up.
Topics: Autoimmune Hypophysitis; Humans; Immunoglobulin G; Male; Middle Aged; Pituitary Diseases; Pituitary Gland; Retrospective Studies
PubMed: 35532784
DOI: 10.1007/s00701-022-05231-9 -
The American Journal of Emergency... Jan 2021A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8 days prior. Her pregnancy was unremarkable and was not...
A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8 days prior. Her pregnancy was unremarkable and was not complicated by pre-eclampsia. She did not present with signs or symptoms consistent with postdural puncture headache or pre-eclampsia. Her delivery was not complicated by hypotension or post-partum hemorrhage. By chance, she was found to be hyponatremic and admitted to internal medicine for further work-up. She was diagnosed with postpartum lymphocytic adenohypophysitis and treated with steroids. She was discharged with a steroid taper and had complete resolution on follow up. Lymphocytic hypophysitis (LH), or commonly known as autoimmune hypophysitis, is a rare inflammatory condition affecting the pituitary gland. Acute LH can result in sudden death as demonstrated in some case reports. The most common symptom in >50% of cases is headache. First-line pharmacological treatment consists of high-dose corticosteroids and is effective in reducing pituitary size and improving endocrine insufficiency in 75% of cases. LH is a potential cause of postpartum headache that can be easily screened for with history and routine bloodwork and has good outcomes with early intervention. LH should be added to the differential for postpartum headaches presenting to the emergency department and routine blood work should be considered for all postpartum headaches.
Topics: Adult; Autoimmune Hypophysitis; Female; Headache; Humans; Puerperal Disorders
PubMed: 32718737
DOI: 10.1016/j.ajem.2020.07.022 -
Nature Reviews. Endocrinology Feb 2021Hypopituitarism is defined as one or more partial or complete pituitary hormone deficiencies, which are related to the anterior and/or posterior gland and can have an... (Review)
Review
Hypopituitarism is defined as one or more partial or complete pituitary hormone deficiencies, which are related to the anterior and/or posterior gland and can have an onset in childhood or adulthood. The most common aetiology is a sellar or suprasellar lesion, often an adenoma, which causes hypopituitarism due to tumour mass effects, or the effects of surgery and/or radiation therapy. However, other clinical conditions, such as traumatic brain injury, and autoimmune and inflammatory diseases, can result in hypopituitarism, and there are also genetic causes of hypopituitarism. Furthermore, the use of immune checkpoint inhibitors to treat cancer is increasing the risk of hypopituitarism, with a pattern of hormone defects that is different from the classic patterns and depends on mechanisms that are specific for each drug. Moreover, autoantibody production against the pituitary and hypothalamus has been demonstrated in studies investigating the development or worsening of some cases of hypopituitarism. Finally, evidence suggests that posterior pituitary damage can affect oxytocin secretion. The aim of this Review is to summarize current knowledge on non-classic and emerging causes of hypopituitarism, so as to help clinicians improve early identification, avoid life-threatening events and improve the clinical care and quality of life of patients at risk of hypopituitarism.
Topics: Adenoma; Adrenocorticotropic Hormone; Autoimmune Hypophysitis; Brain Injuries, Traumatic; Dwarfism, Pituitary; Empty Sella Syndrome; Endocrine System Diseases; Genetic Diseases, Inborn; Humans; Hypoglycemia; Hypogonadism; Hypophysitis; Hypopituitarism; Hypothyroidism; Immune Checkpoint Inhibitors; Oxytocin; Pituitary Apoplexy; Pituitary Neoplasms; Subarachnoid Hemorrhage
PubMed: 33247226
DOI: 10.1038/s41574-020-00437-2