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Abstract 70: High dose intravenous therapy augments complete anterior pituitary hormoanl recovery in primary autoimmune hypophysitis

Background: Glucocorticoid treatment of primary autoimmune hypophysitis (PAH) is well established; however, dose, route, and recovery predictors are not well-defined. Aims: Systematic review of published literature for use of glucocorticoids as first line of management in PAH- to analyze treatment p...

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Detalles Bibliográficos
Autores principales: Brijesh, K, Shah, Ravikumar, Memon, Saba, Patil, Virendra, Lila, Anurag, Shah, Nalini, Bandgar, Tushar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067719/
http://dx.doi.org/10.4103/2230-8210.342187
Descripción
Sumario:Background: Glucocorticoid treatment of primary autoimmune hypophysitis (PAH) is well established; however, dose, route, and recovery predictors are not well-defined. Aims: Systematic review of published literature for use of glucocorticoids as first line of management in PAH- to analyze treatment protocol, baseline and post-treatment clinical, hormonal, and radiological features. Results: 152 cases (females-69.8%; age-41±13.9 years) with PAH [(94-oral steroid group (OSG); 58-intravenous steroid group (IVSG)] were included. Clinical recovery [headache, 79% vs.97%; visual deficits, 58% vs.90%; cranial nerve palsy, 50% vs.87%] between OSG and IVSG were comparable. Complete anterior pituitary hormonal (APH) recovery was significantly higher in IVSG (39.02% vs.20.89%, p=0.04) predominantly due to corticotroph axis recovery (56.7% vs. 27.3%), whereas recovery of other APH axes were not different. Persistent APH deficit was higher in OSG (52.2% vs. 29.3%, p=0.02). Radiologically, regression of pituitary enlargement (72% vs. 64%) and resolution of stalk thickening (76% vs. 64%) between groups was not different. Trend towards lesser recurrence in IVSG (19.3% vs. 32.9%) was seen. Prednisolone equivalent dose (mg)/day was significantly higher in IVSG [30 (24-65) vs. 136 (73-136)] with similar treatment duration (weeks) [8 (8-20) vs. 10 (6-10)]. Reported major adverse effects did not differ between groups. DI predicted poor hormonal recovery in IVSG, while no other parameter affected recovery. Conclusion: High-dose pulse IVS leads to better APH recovery and may decrease recurrence. Preserving the cortisol axis prevents long-term hormone replacement and adrenal crisis in future.