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Hypophysitis: An update on the novel forms, diagnosis and management of disorders of pituitary inflammation.
Best Practice & Research Clinical Endocrinology & Metabolism ( IF 6.1 ) Pub Date : 2019-12-12 , DOI: 10.1016/j.beem.2019.101371
Sriram Gubbi 1 , Fady Hannah-Shmouni 2 , Joseph G Verbalis 3 , Christian A Koch 4
Affiliation  

Hypophysitis is a heterogeneous condition that leads to inflammation of the sella and/or suprasellar region, potentially resulting in hormonal deficiencies and/or mass effects. A preponderance of hypophysitis subtypes have an underlying autoimmune aetiology. The overall incidence and prevalence of hypophysitis has dramatically increased over the past decade, mainly due to increased awareness of the condition in the medical community, improvements in imaging techniques, and a rise in the occurrence of certain forms of hypophysitis such as IgG4 hypophysitis (IgG4Hy) and immune checkpoint inhibitor induced hypophysitis (ICIHy). The clinical presentation varies from an asymptomatic condition to a fatal disease often as a result of electrolyte abnormalities due to glucocorticoid deficiency in the context of adrenal crisis from central adrenal insufficiency. Milder forms of hypophysitis are treated with replacement of deficient hormones while more acute presentations with mass effects require glucocorticoid therapy, immunosuppressive therapy or surgery. Timely diagnosis and interventions are keys to prevention of the lethal complications of this disease. In this review, we provide an update on the recent advances in the field of pituitary autoimmunity, with an emphasis on autoimmune hypophysitis and novel forms of hypophysitis such as anti-PIT1 hypophysitis, IgG4Hy and ICIHy.

中文翻译:

垂体炎:垂体炎症疾病的新形式、诊断和治疗的最新进展。

垂体炎是一种异质性疾病,会导致蝶鞍和/或鞍上区域炎症,可能导致激素缺乏和/或肿块效应。大多数垂体炎亚型都有潜在的自身免疫病因。垂体炎的总体发病率和患病率在过去十年中急剧增加,这主要是由于医学界对该病的认识不断提高、影像学技术的进步以及某些形式的垂体炎(例如 IgG4 垂体炎 (IgG4Hy))发生率的增加。 )和免疫检查点抑制剂诱发的垂体炎(ICIHy)。临床表现多种多样,从无症状到致命疾病,通常是由于中枢肾上腺功能不全导致肾上腺危象时糖皮质激素缺乏导致电解质异常所致。较轻的垂体炎可通过补充缺乏的激素来治疗,而具有肿块效应的较急性的垂体炎则需要糖皮质激素治疗、免疫抑制治疗或手术。及时诊断和干预是预防这种疾病致命并发症的关键。在这篇综述中,我们提供了垂体自身免疫领域的最新进展,重点是自身免疫性垂体炎和新型垂体炎,例如抗 PIT1 垂体炎、IgG4Hy 和 ICIHy。
更新日期:2019-12-12
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