Evaluation and follow-up of patients diagnosed with hypophysitis: a cohort study

Author:

Hacioglu Aysa1ORCID,Karaca Zuleyha1ORCID,Uysal Serhat2,Ozkaya Hande Mefkure2,Kadioglu Pınar2ORCID,Selcukbiricik Ozlem Soyluk3,Gul Nurdan3,Yarman Sema3,Koksalan Damla4,Selek Alev4,Canturk Zeynep4,Cetinarslan Berrin4,Corapcioglu Demet5,Sahin Mustafa5ORCID,Sah Unal Fatma Tugce5,Babayeva Afruz6,Akturk Mujde6,Ciftci Sema7ORCID,Piskinpasa Hamide7,Dokmetas Hatice Sebile8,Dokmetas Meric9,Sahin Onur9,Eraydın Ayten10,Fenkci Semin10,Ozturk Sadettin11,Akarsu Ersin11,Omma Tulay12,Erkan Buruc13ORCID,Burhan Sebnem13ORCID,Pehlivan Koroglu Esma14,Saygili Fusun14,Kilic Kan Elif15,Atmaca Aysegul15,Elbuken Gulsah16,Alphan Uc Ziynet17,Gorar Suheyla18,Hekimsoy Zeliha19,Pekkolay Zafer20,Bostan Hayri21ORCID,Bayram Fahri1,Yorulmaz Goknur22,Sener Selcuk Yusuf23,Turan Kubra24ORCID,Celik Ozlem25,Dogruel Hakan26,Ertorer Eda27ORCID,Turhan Iyidir Ozlem28,Topaloglu Omercan29,Cansu Guven Baris30ORCID,Unluhizarci Kursad1,Kelestimur Fahrettin31ORCID

Affiliation:

1. Department of Endocrinology, Erciyes University Medical School , Kayseri 38039 , Türkiye

2. Department of Endocrinology, Cerrahpasa University Medical School-Cerrahpasa , Istanbul 34098 , Türkiye

3. Department of Endocrinology, Istanbul University Medical School , Istanbul 34093 , Türkiye

4. Department of Endocrinology, Kocaeli University Medical School , Kocaeli 41001 , Türkiye

5. Department of Endocrinology, Ankara University Medical School , Ankara 06230 , Türkiye

6. Department of Endocrinology, Gazi University Medical School , Ankara 06500 , Türkiye

7. Bakirkoy Dr. Sadi Konuk Training and Research Hospital , Istanbul 34180 , Türkiye

8. Department of Endocrinology, Cemil Tascıoglu City Hospital, University of Health Sciences , Istanbul 34384, Türkiye

9. Department of Internal Medicine, Istanbul Medipol University Medical School , Istanbul 34214 , Türkiye

10. Department of Endocrinology, Pamukkale University Medical School , Denizli 20070 , Türkiye

11. Department of Endocrinology, Gaziantep University Medical School , Gaziantep 27070 , Türkiye

12. Department of Endocrinology, Ankara Training and Research Hospital, University of Health Sciences , Ankara 06230 , Türkiye

13. Department of Endocrinology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences , Istanbul 34480 , Türkiye

14. Department of Endocrinology, Ege University Medical School , Izmir 35100 , Türkiye

15. Department of Endocrinology, Ondokuz Mayis University Medical School , Samsun 55200 , Türkiye

16. Department of Endocrinology, Tekirdag Namik Kemal University Medical School , Tekirdag 59100 , Türkiye

17. Department of Endocrinology, Usak Research and Training Hospital , Usak 64100 , Türkiye

18. Department of Endocrinology, Antalya Training and Research Hospital , Antalya 07100 , Türkiye

19. Department of Endocrinology, Celal Bayar University Medical School , Manisa 45030 , Türkiye

20. Department of Endocrinology, Dicle University Medical School , Diyarbakir 21280 , Türkiye

21. Department of Endocrinology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences , Ankara 06110 , Türkiye

22. Department of Endocrinology, Osmangazi University Medical School , Eskisehir 26040 , Türkiye

23. Department of Endocrinology, Maltepe Medical Park Hospital , Istanbul 34846 , Türkiye

24. Department of Endocrinology, Yildirim Beyazit University Medical School , Ankara 06800 , Türkiye

25. Department of Endocrinology, Acibadem University Medical School , Istanbul 34750 , Türkiye

26. Department of Endocrinology, Akdeniz University Medical School , Antalya 07070 , Türkiye

27. Department of Endocrinology, Baskent University Medical School, Adana Hospital , Adana 01250 , Türkiye

28. Department of Endocrinology, Baskent University Medical School, Ankara Hospital , Ankara 06490 , Türkiye

29. Department of Endocrinology, Bulent Ecevit University Medical School , Zonguldak 67630 , Türkiye

30. Department of Endocrinology, Kutahya Health Science University , Kutahya 43100 , Türkiye

31. Department of Endocrinology, Yeditepe University Medical School , Istanbul 34718 , Türkiye

Abstract

Abstract Objective Primary hypophysitis might be challenging to diagnose, and there is a lack of evidence regarding optimal treatment strategies due to rarity of the disease. We aim to investigate the clinical features and compare the outcomes of different management strategies of primary hypophysitis in a large group of patients recruited on a nationwide basis. Design A retrospective observational study. Methods The demographic, clinical, and radiologic features and follow-up data were collected in study protocol templates and analyzed. Results One hundred and thirteen patients (78.8% female, median age: 36 years) were included. Lymphocytic (46.7%) and granulomatous hypophysitis (35.6%) were the prevailing subtypes out of 45 patients diagnosed after pathologic investigations. Headache (75.8%) was the most common symptom, and central hypogonadism (49.5%) was the most common hormone insufficiency. Of the patients, 52.2% were clinically observed without interventions, 18.6% were started on glucocorticoid therapy, and 29.2% underwent surgery at presentation. Headache, suprasellar extension, and chiasmal compression were more common among glucocorticoid-treated patients than who were observed. Cox regression analysis revealed higher hormonal and radiologic improvement rates in the glucocorticoid-treated group than observation group (hazard ratio, 4.60; 95% CI, 1.62-12.84 and HR, 3.1; 95% CI, 1.40-6.68, respectively). The main indication for surgery was the inability to exclude a pituitary adenoma in the presence of compression symptoms, with a recurrence rate of 9%. Conclusion The rate of spontaneous improvement might justify observation in mild cases. Glucocorticoids proved superior to observation in terms of hormonal and radiologic improvements. Surgery may not be curative and might be considered in indeterminate, treatment-resistant, or severe cases.

Publisher

Oxford University Press (OUP)

Reference33 articles.

1. Hypophysitis, the growing spectrum of a rare pituitary disease;Langlois;J Clin Endocrinol Metab,2022

2. Autoimmune hypophysitis;Caturegli;Endocr Rev,2005

3. How reliably can autoimmune hypophysitis be diagnosed without pituitary biopsy;Howlett;Clin Endocrinol (Oxf),2010

4. The management of hypophysitis;Karaca;Minerva Endocrinol,2016

5. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline;Bornstein;J Clin Endocrinol Metab,2016

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