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Hypophysitis

Year 2020, Issue: 4, 561 - 566, 01.12.2020

Müjdat Kara

Abstract

Hypophysitis is an autoimmune heterogeneous inflammatory disease of the pituitary gland. It is seen in two forms being primary and secondary. Lymphocytic hypophysitis is the most commonly observed form of hypophysitis and it is a disease capable of disrupting the hormonal secretions of the pituitary gland, imitating pituitary adenomas, and sometimes even causes mortality due to pituitary failure. The purpose of the treatment is to reduce the existing symptoms, to minimize the hypophyseal tumor and to eliminate the resultant hormonal deficiencies. The most commonly used medications in medical treatment are the glucocorticoids and they ensure minimization of the pituitary gland and improve pituitary function. In cases of glucocorticoids inadequacy, the other immunosuppressive medications, such as azathioprine, methotrexate and cyclosporine A, might be used. Surgical treatment might be necessary in some cases. In this evaluation, in the light of most up-to-date literature information, classification of hypophysitis, its clinical importance and treatment approaches are discussed

Keywords

Hypophysitis lymphocytic hypophysitis

References

  • Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR. Autoimmune Hypophysitis. Endocr Rev 2005;26:599–614. [CrossRef]
  • Lupi I, Manetti L, Raffaelli V, Lombardi M, Cosottini M, Iannelli A, et al. Diagnosis and Treatment of Autoimmune Hypophysitis: A Short Review. J Endocrinol Invest 2011;34:e245–52. [CrossRef]
  • Goudi EB, Pinkerton PH. Anterior Hypophysitis and Hashimoto’s Disease in a Young Woman. J Pathol Bacteriol 1962;83:584–85. [CrossRef]
  • Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, et al. Diagnosis of Primary Hypophysitis in Germany. J Clin Endocrinol Metab 2015;100:3841–9. [CrossRef]
  • Betterle C, Greggio NA, Volpato M. Clinical Review 93: Autoimmune Polyglandular Syndrome Type 1. J Clin Endocrinol Metab 1998;83:1049–55. [CrossRef]
  • Heaney AP, Sumerel B, Rajalingam R, Bergsneider M, Yong WH, Liau LM. HLA Markers DQ8 and DR53 are Associated with Lymphocytic Hypophysitis and May Aid in Differential Diagnosis. J Clin Endocrinol Metab 2015;100:4092–7. [CrossRef]
  • Yaoita R, Ito M, Matsuda K, Kokubo Y, Sato S, Sonoda Y. A Case of Lymphocytic Adenohypophysitis Presenting Visual Disturbance in the Third Trimester of Pregnancy. No Shinkei Geka. 2017;45:161-5. [CrossRef]
  • Lammert A, Schneider HJ, Bergmann T, Benck U, Kramer BK, Gärtner R, et al. Hypophysitis Caused by Ipilimumab in Cancer Patients: Hormone Replacement or Immunosuppressive Therapy. Exp Clin Endocrinol Diabetes 2013;121:581–7. [CrossRef]
  • Faje A. Immunotherapy and Hypophysitis: Clinical Presentation, Treatment, and Biologic Insights. Pituitary 2016;19:82–92. [CrossRef]
  • Tebben PJ, Atkinson JL, Scheithauer BW, Erickson D. Granulomatous Adenohypophysitis After Interferon and Ribavirin Therapy. Endocr Pract 2007;13:169–75. [CrossRef]
  • Gutenberg A, Caturegli P, Metz I, Martinez R, Mohr A, Brück W, Rohde V. Necrotizing Infundibulo-Hypophysitis: an Entity too Rare to be True? Pituitary 2012;15:202–8. [CrossRef]
  • De Lange TE, Simsek S, Kramer MH, Nanayakkara PW. A Case of Cocaine-Induced Panhypopituitarism with Human Neutrophil Elastase-Specific Anti-Neutrophil Cytoplasmic Antibodies. Eur J Endocrinol 2009;160:499–502. [CrossRef]
  • Hori M, Makita N, Andoh T, Takiyama H, Yajima Y, Sakatani T, et al. Long-term Clinical Course of IgG4-Related Systemic Disease Accompanied by Hypophysitis. Endocr J 2010;57:485–92. [CrossRef]
  • Asa SL. Tumors of the Pituitary Gland. Atlas of tumor pathology. 3rd series, Fascicle 22. Washington DC: Armed Forces Institute of Pathology; 1998. pp.191–210.
  • Caturegli P, Lupi I, Landek-Salgado M, Kimura H, Rose NR. Pituitary Autoimmunity: 30 Years Later. Autoimmun Rev 2008;7:631–7. [CrossRef]
  • Rivera JA. Lymphocytic Hypophysitis: Disease Spectrum and Approach to Diagnosis and Therapy. Pituitary 2006;9:35–45. [CrossRef]
  • Freda PU, Post KD. Differential Diagnosis of Sellar Masses. Endocrinol Metab Clin North Am 1999;28:81–117. [CrossRef]
  • Kristof RA, Van Roost D, Klingmüller D, Springer W, Schramm J. Lymphocytic Hypophysitis: Noninvasive Diagnosis and Treatment by High Dose Methylprednisolone Pulse Therapy? J Neurol Neurosurg Psychiatry 1999;67:398–402. [CrossRef]
  • Sato N, Sze G, Endo K. Hypophysitis: Endocrinologic and Dynamic MR Findings. AJNR Am J Neuroradiol 1998;19:439–44.
  • Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O. Characteristic Features of 20 Patients with Sheehan’s Syndrome. Gynecol Endocrinol 2006;22:279–83. [CrossRef]
  • Honegger J, Buchfelder M, Schlaffer S, Droste M, Werner S, Strasburger C, et al. Pituitary Working Group of the German Society of Endocrinology. Treatment of Primary Hypophysitis in Germany. J Clin Endocrinol Metab 2015;100:3460–9. [CrossRef]
  • De Bellis A, Colao A, Savoia A, Coronella C, Pasquali D, Conte M, et al. Effect of Long-Term Cabergoline Therapy on the Immunological Pattern and Pituitary Function of Patients with Idiopathic Hyperprolactinaemia Positive for Antipituitary Antibodies. Clin Endocrinol 2008;69:285–91. [CrossRef]
  • Schreckinger M, Francis T, Rajah G, Jagannathan J, Guthikonda M, Mittal S. Novel Strategy to Treat a Case of Recurrent Lymphocytic Hypophysitis Using Rituximab. J Neurosurg 2012;116:1318–23. [CrossRef]
  • Pekic S, Popovic V. Diagnosis of Endocrine Disease: Expanding the Cause of Hypopituitarism. Eur J Endocrinol 2017;176:R269–82. [CrossRef]
  • De Bellis A, Bizzarro A, Bellastella A. Pituitary Antibodies and Lymphocytic Hypophysitis. Best Pract Res Clin Endocrinol Metab 2005;19:67–84. [CrossRef]
  • Khare S, Jagtap VS, Budyal SR, Kasaliwal R, Kakade HR, Bukan A, et al. Primary (Autoimmune) Hypophysitis: a Single Centre Experience. Pituitary 2015;18:16–22. [CrossRef]
  • Honegger J, Buchfelder M, Schlaffer S, Droste M, Werner S, Strasburger C, et al. Treatment of Primary Hypophysitis in Germany. J Clin Endocrinol Metab 2015;100:3460–9. [CrossRef]
  • Park SM, Bae JC, Joung JY, Cho YY, Kim TH, Jin SM, et al. Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis. Endocrinol Metab (Seoul) 2014;29:470–8. [CrossRef]
  • Imber BS, Lee HS, Kunwar S, Blevins LS, Aghi MK. Hypophysitis: a Single-Center Case Series. Pituitary 2015;18:630–41. [CrossRef]
  • Ray DK, Yen CP, Vance ML, Laws ER, Lopes B, Sheehan JP. Gamma Knife Surgery for Lymphocytic Hypophysitis. J Neurosurg 2010;112:118– 21. [CrossRef]

Hipofizit

Year 2020, Issue: 4, 561 - 566, 01.12.2020

Müjdat Kara

Abstract

Hipofizit, hipofiz bezinin otoimmun heterojen inflamatuar bir hastalığıdır. Primer ve sekonder olmak üzere 2 formda görülür. Lenfositik hipofizit en sık görülen hipofizit formudur ve hipofizin hormonal sekresyonlarını bozabilen, hipofiz adenomlarını taklit edebilen ve bazen hipofiz yetersizliği ile mortaliteye neden olabilen bir hastalıktır. Tedavide amaç var olan semptomların azaltılması, hipofizer kitlenin küçültülmesi ve meydana gelen hormonal eksikliklerin giderilmesidir. Medikal tedavide en sık kullanılan ilaçlar glukokortikoidlerdir ve hipofiz bezinin küçülmesini ve hipofiz fonksiyonlarının düzelmesini sağlarlar. Glukokortikoidlerin yetersiz kaldığı olgularda azotiopurin, methotrexate, cyclosporin A gibi diğer immusupresif ilaçlar kullanılabilir. Cerrahi tedavi bazı olgularda gerekli olabilir. Bu değerlendirmede, güncel literatür bilgileri ışığında hipofizitin sınıflaması, klinik önemi ve tedavi yaklaşımları tartışılmıştır

Keywords

Hipofizit lenfositik hipofizit

References

  • Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR. Autoimmune Hypophysitis. Endocr Rev 2005;26:599–614. [CrossRef]
  • Lupi I, Manetti L, Raffaelli V, Lombardi M, Cosottini M, Iannelli A, et al. Diagnosis and Treatment of Autoimmune Hypophysitis: A Short Review. J Endocrinol Invest 2011;34:e245–52. [CrossRef]
  • Goudi EB, Pinkerton PH. Anterior Hypophysitis and Hashimoto’s Disease in a Young Woman. J Pathol Bacteriol 1962;83:584–85. [CrossRef]
  • Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, et al. Diagnosis of Primary Hypophysitis in Germany. J Clin Endocrinol Metab 2015;100:3841–9. [CrossRef]
  • Betterle C, Greggio NA, Volpato M. Clinical Review 93: Autoimmune Polyglandular Syndrome Type 1. J Clin Endocrinol Metab 1998;83:1049–55. [CrossRef]
  • Heaney AP, Sumerel B, Rajalingam R, Bergsneider M, Yong WH, Liau LM. HLA Markers DQ8 and DR53 are Associated with Lymphocytic Hypophysitis and May Aid in Differential Diagnosis. J Clin Endocrinol Metab 2015;100:4092–7. [CrossRef]
  • Yaoita R, Ito M, Matsuda K, Kokubo Y, Sato S, Sonoda Y. A Case of Lymphocytic Adenohypophysitis Presenting Visual Disturbance in the Third Trimester of Pregnancy. No Shinkei Geka. 2017;45:161-5. [CrossRef]
  • Lammert A, Schneider HJ, Bergmann T, Benck U, Kramer BK, Gärtner R, et al. Hypophysitis Caused by Ipilimumab in Cancer Patients: Hormone Replacement or Immunosuppressive Therapy. Exp Clin Endocrinol Diabetes 2013;121:581–7. [CrossRef]
  • Faje A. Immunotherapy and Hypophysitis: Clinical Presentation, Treatment, and Biologic Insights. Pituitary 2016;19:82–92. [CrossRef]
  • Tebben PJ, Atkinson JL, Scheithauer BW, Erickson D. Granulomatous Adenohypophysitis After Interferon and Ribavirin Therapy. Endocr Pract 2007;13:169–75. [CrossRef]
  • Gutenberg A, Caturegli P, Metz I, Martinez R, Mohr A, Brück W, Rohde V. Necrotizing Infundibulo-Hypophysitis: an Entity too Rare to be True? Pituitary 2012;15:202–8. [CrossRef]
  • De Lange TE, Simsek S, Kramer MH, Nanayakkara PW. A Case of Cocaine-Induced Panhypopituitarism with Human Neutrophil Elastase-Specific Anti-Neutrophil Cytoplasmic Antibodies. Eur J Endocrinol 2009;160:499–502. [CrossRef]
  • Hori M, Makita N, Andoh T, Takiyama H, Yajima Y, Sakatani T, et al. Long-term Clinical Course of IgG4-Related Systemic Disease Accompanied by Hypophysitis. Endocr J 2010;57:485–92. [CrossRef]
  • Asa SL. Tumors of the Pituitary Gland. Atlas of tumor pathology. 3rd series, Fascicle 22. Washington DC: Armed Forces Institute of Pathology; 1998. pp.191–210.
  • Caturegli P, Lupi I, Landek-Salgado M, Kimura H, Rose NR. Pituitary Autoimmunity: 30 Years Later. Autoimmun Rev 2008;7:631–7. [CrossRef]
  • Rivera JA. Lymphocytic Hypophysitis: Disease Spectrum and Approach to Diagnosis and Therapy. Pituitary 2006;9:35–45. [CrossRef]
  • Freda PU, Post KD. Differential Diagnosis of Sellar Masses. Endocrinol Metab Clin North Am 1999;28:81–117. [CrossRef]
  • Kristof RA, Van Roost D, Klingmüller D, Springer W, Schramm J. Lymphocytic Hypophysitis: Noninvasive Diagnosis and Treatment by High Dose Methylprednisolone Pulse Therapy? J Neurol Neurosurg Psychiatry 1999;67:398–402. [CrossRef]
  • Sato N, Sze G, Endo K. Hypophysitis: Endocrinologic and Dynamic MR Findings. AJNR Am J Neuroradiol 1998;19:439–44.
  • Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O. Characteristic Features of 20 Patients with Sheehan’s Syndrome. Gynecol Endocrinol 2006;22:279–83. [CrossRef]
  • Honegger J, Buchfelder M, Schlaffer S, Droste M, Werner S, Strasburger C, et al. Pituitary Working Group of the German Society of Endocrinology. Treatment of Primary Hypophysitis in Germany. J Clin Endocrinol Metab 2015;100:3460–9. [CrossRef]
  • De Bellis A, Colao A, Savoia A, Coronella C, Pasquali D, Conte M, et al. Effect of Long-Term Cabergoline Therapy on the Immunological Pattern and Pituitary Function of Patients with Idiopathic Hyperprolactinaemia Positive for Antipituitary Antibodies. Clin Endocrinol 2008;69:285–91. [CrossRef]
  • Schreckinger M, Francis T, Rajah G, Jagannathan J, Guthikonda M, Mittal S. Novel Strategy to Treat a Case of Recurrent Lymphocytic Hypophysitis Using Rituximab. J Neurosurg 2012;116:1318–23. [CrossRef]
  • Pekic S, Popovic V. Diagnosis of Endocrine Disease: Expanding the Cause of Hypopituitarism. Eur J Endocrinol 2017;176:R269–82. [CrossRef]
  • De Bellis A, Bizzarro A, Bellastella A. Pituitary Antibodies and Lymphocytic Hypophysitis. Best Pract Res Clin Endocrinol Metab 2005;19:67–84. [CrossRef]
  • Khare S, Jagtap VS, Budyal SR, Kasaliwal R, Kakade HR, Bukan A, et al. Primary (Autoimmune) Hypophysitis: a Single Centre Experience. Pituitary 2015;18:16–22. [CrossRef]
  • Honegger J, Buchfelder M, Schlaffer S, Droste M, Werner S, Strasburger C, et al. Treatment of Primary Hypophysitis in Germany. J Clin Endocrinol Metab 2015;100:3460–9. [CrossRef]
  • Park SM, Bae JC, Joung JY, Cho YY, Kim TH, Jin SM, et al. Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis. Endocrinol Metab (Seoul) 2014;29:470–8. [CrossRef]
  • Imber BS, Lee HS, Kunwar S, Blevins LS, Aghi MK. Hypophysitis: a Single-Center Case Series. Pituitary 2015;18:630–41. [CrossRef]
  • Ray DK, Yen CP, Vance ML, Laws ER, Lopes B, Sheehan JP. Gamma Knife Surgery for Lymphocytic Hypophysitis. J Neurosurg 2010;112:118– 21. [CrossRef]
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Müjdat Kara

Publication Date December 1, 2020
Published in Issue Year 2020Issue: 4

Cite

EndNote Kara M (December 1, 2020) Hipofizit. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 4 561–566.