Variations In Clinical And Imaging Findings By Time Of Diagnosis In Females With Hypopituitarism Attributed To Lymphocytic Hypophysitis |
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| Institution: | 1. From the Endocrine Institute, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Endocrine Institute, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel;4. Endocrinology Clinic, Division of Maternal and Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel;5. Endocrine Institute, Meir Medical Center, Kfar Saba, Israel.;1. Endocrinology & Metabolism Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel;2. Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel;3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.;1. From the Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy;2. Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy. |
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| Abstract: | Objective: To describe the various patterns of presentation, including assisting analyses, associated with the timing of diagnosis of females with hypopituitarism and suspected clinical diagnosis of lymphocytic hypophysitis.Methods: A retrospective study of 9 consecutive females with pituitary dysfunction developed during or after pregnancy. All subjects were treated in our clinics between 2008 and 2014. Data were collected on clinical characteristics, pituitary hormone levels, and imaging findings.Results: The study group included 9 patients with a mean age 33.7 ± 7.8 years at delivery. The probable cause of disease was lymphocytic hypophysitis. Headache or specific symptoms/signs of hypopituitarism appeared within 1 year of delivery. Five patients had headache, and 8 had difficulty breastfeeding or amenorrhea. Laboratory findings included central hypocortisolism (8/9 patients), hypogonadotropic hypogonadism (8/9), and central hypothyroidism (6/7). Insulin-like growth factor-1 (IGF-1) levels were low in 8/8 patients. Prolactin levels were low in 3/9 patients, and 1 patient had diabetes insipidus. Seven patients were diagnosed less than 1 year from symptom onset; 4 (57%) complained of headaches, and 5 (71%) had panhypopituitarism. Two patients were diagnosed later. Both had difficulty breastfeeding and amenorrhea, and one also had headaches. Both had panhypopituitarism and reduced pituitary volume. None of the patients fully recovered pituitary function. Normalization of the thyrotroph axis occurred in 3 patients, gonadotroph function in 3, the corticotroph axis in 2, and IGF-1 normalized in 1 subject.Conclusion: Hypopituitarism attributed to lymphocytic hypophysitis may present during pregnancy or early postpartum period with a clear clinical picture, or later, with indolent and nonspecific symptoms and signs.Abbreviations:ACTH = adrenocorticotropic hormoneDI = diabetes insipidusFSH = follicle-stimulating hormoneGH = growth hormoneIGF-1 = insulin-like growth factor-1LH = luteinizing hormoneLT4 = levothyroxineMRI = magnetic resonance imagingT4 = thyroxineTSH = thyroid stimulating hormone |
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