Pituitary Inflammation (Hypophysitis)
Hypophysitis is inflammation of the pituitary gland or pituitary stalk and typically results in varying degrees of pituitary gland failure
There are several types or possible causes of pituitary gland inflammation (also known as hypophysitis). The most common type is lymphocytic hypophysitis followed by granulomatous hypophysitis. Classic lymphocytic hypophysitis occurs predominantly in woman during or after pregnancy, but it can occur in men as well, and across a wide age spectrum. A relatively new form of hypophysitis has recently been described in patients undergoing immunotherapy as a cancer treatment, most commonly in patients with metastatic melanoma being treated with ipilimumab (a human monoclonal antibody against cytotoxic T-lymphocyte antigen 4 ).
The most common symptoms and signs of hypophysitis are anterior and posterior pituitary gland failure (which may include adrenal insufficiency, hypothyroidism, hypogonadism, growth hormone deficiency, as well as diabetes insipidus). Other common symptoms include headache and visual loss.
A presumptive diagnosis of hypophysitis can be made in a patient with otherwise unexplained hypopituitarism with characteristic findings on pituitary MRI of diffuse pituitary gland enlargement and/or a thickened pituitary stalk (infundibulum). In a minority of patients with presumed hypophysitis, a pituitary biopsy may be warranted to confirm the diagnosis if MRI findings are not completely convincing. Pituitary surgery may also be indicated for patients with visual loss from the enlarged pituitary gland impinging upon the optic nerves or optic chiasm. Such a pituitary biopsy can be safely done with an endoscopic endonasal approach.
Treatment of hypophysitis is typically with hormone replacement therapy and with high dose glucocorticoids (steroids) to reduce inflammation. Despite long-term treatment with steroids, most patients do develop some degree of permanent pituitary gland failure.
At the Pacific Pituitary Disorders Center we have one of the world’s largest and most extensive experiences in diagnosing and treating patients with hypopituitarism of all causes. Our team of pituitary endocrinologists and neurosurgeons work closely together to preserve or restore pituitary gland function and quality of life.