Hypophysitis: Evaluation and Management

Abstract

Hypophysitis is the acute or chronic inflammation of the pituitary gland. The spectrum of hypophysitis has expanded in recent years with the addition of two histologic subtypes and recognition as a complication of treatment with immune checkpoint inhibitors. Despite the increased number of published cases, the pathogenesis of hypophysitis is poorly understood, and treatment strategies are diverse and controversial. The diagnosis of hypophysitis generally requires histopathologic confirmation. The presentation and clinical course of hypophysitis varies. Hypophysitis can resolve spontaneously, relapse may occur, and some cases can be refractory to treatment.

Keywords: Diabetes insipidus; Hypophysitis; Hypopituitarism.

Fig. 1

Hypophysitis was diagnosed in a 30 year old during the late third trimester of pregnancy. The patient presented with 3 weeks of progression vision loss. Panel a depicts a coronal pre-contrast T1-weighted image of the pituitary. Transsphenoidal biopsy (Panel b) demonstrated lymphocytic hypophysitis and glucocorticoid therapy was begun with prednisone 60 mg daily. Following delivery, the pituitary gland decreased in size (Panel c) and remained stable 2 months (Panel d) and 5 months (Panel e) after glucocorticoid taper and discontinuation