The symptoms, diagnosis and treatment of Hypophysitis
Hypophysitis is a rare condition which involves the acute or chronic inflammation of the pituitary gland or pituitary stalk.
The most common form is lymphocytic hypophysitis which is believed to be an autoimmune disorder. Originally thought to mostly affect women during or after pregnancy, it is now recognised as a disorder affecting both men and women and over a large age range.
In addition a new form has recently been described in patients receiving immunotherapy treatment for cancer – mostly those with metastatic melanoma being treated with anti-CTLA4 and anti PDi treatment (for more details about the side effects of immunotherapy please see this blog post) http://www.markvanderpump.co.uk/blog/posts/-endocrine-disorders-as-a-side-effect-of-immunotherapy-drugs
Symptoms of Hypophysitis
- The most common symptom is a headache which becomes severe with no relief. This is caused by the compression of the optic nerves which may also cause blurred vision, double vision or loss of vision.
- There may be nausea and vomiting.
- Patients may be diagnosed with diabetes insipidus whereby they produce more than usual amounts of dilute urine.
- They may also experience extreme thirst.
- There may be high levels of prolactin in the blood (this is the hormone which helps initiate and maintain lactation)
As this disease is still poorly defined - with symptoms evolving differently in each patient - diagnosis can be extremely challenging.
Furthermore some symptoms could be attributed to other diseases. For example it’s sometimes difficult to tell the difference between hypophysitis and a pituitary tumour on an MRI scan - so a definitive diagnosis may require biopsy.
It is recommended that patients with suspected hypophysitis should receive a complete evaluation for pituitary hormone function – preferably by an endocrinologist.
This is initially based on the use of corticosteroids to reduce the inflammation. Most patients will develop one or more pituitary hormone deficiencies which will then require replacement with appropriate hormone medications.
Where there is a lack of response despite vigorous medical treatment, an endoscopic surgical procedure may be required to reduce part or all of the mass. Every effort is made to avoid normal pituitary tissue during this procedure.
I hope you have found this helpful
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