Early pulse glucocorticoid therapy and improved hormonal outcomes in primary hypophysitis.

Abstract

Introduction: Role of glucocorticoids in primary autoimmune hypophysitis (PAH) has been fraught with variability in regimens leading to inconsistent outcomes in terms of anterior pituitary (AP) hormonal recovery. Hence, we aimed to compare the clinical, hormonal, and radiological outcomes of the standardized high-dose glucocorticoid therapy group (GTG) in PAH with a matched clinical observation group (COG). Methods: 39 retrospective patients with PAH, evaluated and treated at a single center in Western India from 1999-2019 with a median follow-up duration of 48 months were subdivided into GTG (n=18) and COG (n=21) and compared for the outcomes Results: Baseline demographic, hormonal, and radiological features matched between the groups except pituitary height, which was significantly higher in GTG. Cortisol, thyroid, and gonadal axes were affected in 25 (64%), 22 (56%), and 21 (54%) respectively and central diabetes insipidus was seen in 7 (18%) patients. Panhypophysitis (PH) was the most common radiological sub-type (n=33, 84.6%) . The resolution of mass effects was similar in both groups. Overall and complete AP hormonal recovery was significantly higher in GTG compared to COG[12/14 (85.7%) vs. 6/14 (42.8%), p=0.02; 10/14 (71.4%) vs. 1/14 (7.7%), p=0.0007, respectively]. Proportion of cases with empty sella were significantly higher in COG [9/20 (45%) vs 1/17 (5.9%), p= 0.001). Among PH patients in GTG (n=17), we found duration from symptoms-onset to treatment as the predictor of recovery Conclusion: In a PH subtype-predominant PAH cohort, a standardized high-dose glucocorticoid regimen resulted in higher overall and complete AP hormonal recovery than COG. Initiation of glucocorticoids in the early disease course may have been contributory.