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Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis

BACKGROUND: Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established. METHODS: Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were re...

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Autores principales: Park, Sun Mi, Bae, Ji Cheol, Joung, Ji Young, Cho, Yoon Young, Kim, Tae Hun, Jin, Sang-Man, Suh, Sunghwan, Hur, Kyu Yeon, Kim, Kwang-Won
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Endocrine Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285029/
https://www.ncbi.nlm.nih.gov/pubmed/25325267
http://dx.doi.org/10.3803/EnM.2014.29.4.470
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author Park, Sun Mi
Bae, Ji Cheol
Joung, Ji Young
Cho, Yoon Young
Kim, Tae Hun
Jin, Sang-Man
Suh, Sunghwan
Hur, Kyu Yeon
Kim, Kwang-Won
author_facet Park, Sun Mi
Bae, Ji Cheol
Joung, Ji Young
Cho, Yoon Young
Kim, Tae Hun
Jin, Sang-Man
Suh, Sunghwan
Hur, Kyu Yeon
Kim, Kwang-Won
author_sort Park, Sun Mi
collection PubMed
description BACKGROUND: Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established. METHODS: Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed. RESULTS: Among 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency. CONCLUSION: Deficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement.
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spelling pubmed-42850292015-01-06 Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis Park, Sun Mi Bae, Ji Cheol Joung, Ji Young Cho, Yoon Young Kim, Tae Hun Jin, Sang-Man Suh, Sunghwan Hur, Kyu Yeon Kim, Kwang-Won Endocrinol Metab (Seoul) Original Article BACKGROUND: Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established. METHODS: Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed. RESULTS: Among 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency. CONCLUSION: Deficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement. Korean Endocrine Society 2014-12 2014-12-29 /pmc/articles/PMC4285029/ /pubmed/25325267 http://dx.doi.org/10.3803/EnM.2014.29.4.470 Text en Copyright © 2014 Korean Endocrine Society http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Sun Mi
Bae, Ji Cheol
Joung, Ji Young
Cho, Yoon Young
Kim, Tae Hun
Jin, Sang-Man
Suh, Sunghwan
Hur, Kyu Yeon
Kim, Kwang-Won
Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
title Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
title_full Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
title_fullStr Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
title_full_unstemmed Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
title_short Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
title_sort clinical characteristics, management, and outcome of 22 cases of primary hypophysitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285029/
https://www.ncbi.nlm.nih.gov/pubmed/25325267
http://dx.doi.org/10.3803/EnM.2014.29.4.470
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