Introduction: Role of glucocorticoids in primary autoimmune hypophysitis (PAH) has been fraught with variability in regimens leading to inconsistent outcomes in terms of anterior pituitary (AP) hormonal recovery. Hence, we aimed to compare the clinical, hormonal, and radiological outcomes of the standardized high-dose glucocorticoid therapy group (GTG) in PAH with a matched clinical observation group (COG). Methods: 39 retrospective patients with PAH, evaluated and treated at a single center in Western India from 1999-2019 with a median follow-up duration of 48 months were subdivided into GTG (n=18) and COG (n=21) and compared for the outcomes Results: Baseline demographic, hormonal, and radiological features matched between the groups except pituitary height, which was significantly higher in GTG. Cortisol, thyroid, and gonadal axes were affected in 25 (64%), 22 (56%), and 21 (54%) respectively and central diabetes insipidus was seen in 7 (18%) patients. Panhypophysitis (PH) was the most common radiological sub-type (n=33, 84.6%) . The resolution of mass effects was similar in both groups. Overall and complete AP hormonal recovery was significantly higher in GTG compared to COG[12/14 (85.7%) vs. 6/14 (42.8%), p=0.02; 10/14 (71.4%) vs. 1/14 (7.7%), p=0.0007, respectively]. Proportion of cases with empty sella were significantly higher in COG [9/20 (45%) vs 1/17 (5.9%), p= 0.001). Among PH patients in GTG (n=17), we found duration from symptoms-onset to treatment as the predictor of recovery Conclusion: In a PH subtype-predominant PAH cohort, a standardized high-dose glucocorticoid regimen resulted in higher overall and complete AP hormonal recovery than COG. Initiation of glucocorticoids in the early disease course may have been contributory.


中文翻译：

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早期脉冲糖皮质激素治疗和改善原发性垂体炎的激素结果。

简介：糖皮质激素在原发性自身免疫性垂体炎 (PAH) 中的作用充满了不同的治疗方案，导致垂体前叶 (AP) 激素恢复方面的结果不一致。因此，我们旨在比较 PAH 中标准化大剂量糖皮质激素治疗组 (GTG) 与匹配的临床观察组 (COG) 的临床、激素和放射学结果。方法：1999 年至 2019 年在印度西部单一中心评估和治疗的 39 例 PAH 回顾性患者，中位随访时间为 48 个月，分为 GTG（n=18）和 COG（n=21）并进行比较结果：基线人口统计学、激素和放射学特征在各组之间匹配，但垂体高度除外，垂体高度在 GTG 中显着更高。皮质醇、甲状腺、分别有 25 名 (64%)、22 名 (56%) 和 21 名 (54%) 患者受到影响，7 名 (18%) 患者出现中枢性尿崩症。全垂体炎 (PH) 是最常见的放射学亚型 (n=33, 84.6%)。两组的质量效应的分辨率相似。与 COG 相比，GTG 的整体和完全 AP 激素恢复显着高于 COG[12/14 (85.7%) 与 6/14 (42.8%)，p=0.02；10/14 (71.4%) vs. 1/14 (7.7%), p=0.0007, 分别]。COG 中空蝶鞍病例的比例显着较高 [9/20 (45%) 对 1/17 (5.9%)，p = 0.001)。在 GTG (n=17) 的 PH 患者中，我们发现从症状发作到治疗的持续时间是康复的预测因子荷尔蒙恢复比 COG 好。