Primary hypophysitis: clinical-pathological correlations
| Autor: | Michael Buchfelder, Wolfgang Brück, Volkmar Hans, Patrizio Caturegli, Maximilian J A Puchner, Angelika Gutenberg, J Kreutzer |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Pituitary gland medicine.medical_specialty Hormone Replacement Therapy Hypophysitis Pituitary Diseases Endocrinology Diabetes and Metabolism Pituitary Function Tests Visual Acuity Optic chiasm 030209 endocrinology & metabolism 03 medical and health sciences 0302 clinical medicine Endocrinology Anterior pituitary Pregnancy Posterior pituitary Internal medicine Biopsy Xanthomatosis medicine Humans Meningitis Lymphocytes Glucocorticoids Hypophysectomy Pituitary stalk Granuloma medicine.diagnostic_test business.industry General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging Hormones 3. Good health medicine.anatomical_structure Pituitary Gland Diabetes insipidus Female Visual Fields business 030217 neurology & neurosurgery |
| Zdroj: | European Journal of Endocrinology. 155:101-107 |
| ISSN: | 1479-683X 0804-4643 |
| DOI: | 10.1530/eje.1.02183 |
| Popis: | Objective: Primary hypophysitis comprises of three distinct histomorphological entities: lymphocytic, granulomatous and xanthomatous. Clinical features of the three subtypes for diagnostic and treatment strategies have yet not been well characterized. Methods: Endocrine function, visual fields and acuity as well as magnetic resonance imaging characteristics were assessed before and after transphenoidal surgery in the largest series of 31 patients with primary hypophysitis (21 lymphocytic, 6 granulomatous, and 4 xanthomatous cases). Results: Only lymphocytic hypophysitis occurred during pregnancy (30%) and was associated with other autoimmune diseases (24%). Visual fields and acuity abnormalities were not seen in xanthomatous hypophysitis. Lymphocytic and granulomatous hypophysitis most often resulted in severe dysfunction of the adrenal, gonadal and thyroidal axes as well as diabetes insipidus. For patients presenting with xanthomatous hypophysitis most often, mild anterior pituitary axis failure was documented and posterior pituitary involvement was hardly found. The outcome after transphenoidal biopsy was generally favorable. Pre- or postsurgical glucocorticoid treatment was very effective in 75% of the lymphocytic form in reducing the pituitary size. In contrast, glucocorticoid therapy was less effective in granulomatous or xanthomatous hypophysitis. Conclusion: Diffuse destruction of the complete pituitary gland including the infundibulum has to be considered in lymphocytic and granulomatous hypophysitis, whereas in xanthomatous, a circumscribed anterior pituitary lesion leading to compression of the pituitary gland without alteration of the pituitary stalk and optic chiasm can be assumed. |
| Databáze: | OpenAIRE |
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