Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, via Paradisa, 2 56124 Pisa, Italy.
J Endocrinol Invest. 2011 Sep;34(8):e245-52. doi: 10.3275/7863. Epub 2011 Jul 12.
Medical therapy of autoimmune hypophysitis with immunosuppressive drugs can be effective to induce remission of the disease by treating both pituitary dysfunction and compression symptoms. We describe the case of a 41-yr-old man with autoimmune hypophysitis in whom prednisone therapy induced remission of the disease but was followed by a sudden relapse after withdrawal. A second trial of corticosteroid was started and succeeded in inducing remission of the disease. Eight months after the second withdrawal pituitary function was restored, pituitary mass had disappeared, only partial diabetes insipidus remained unchanged. Review of the literature identified 30 articles, among case reports and case series, reporting a total of 44 cases of autoimmune hypophysitis treated with glucocorticoids and/or azathioprine. Combining all the cases, medical therapy resulted to be effective in reducing the pituitary mass in 84%, in improving anterior pituitary function in 45%, and in restoring posterior pituitary function in 41%. Clinical aspects of autoimmune hypophysitis are discussed and a possible algorithm for the diagnosis and treatment of the disease is proposed.
自身免疫性垂体炎采用免疫抑制剂的医学治疗可以通过治疗垂体功能障碍和压迫症状来有效诱导疾病缓解。我们描述了一例自身免疫性垂体炎患者，他接受泼尼松治疗后疾病缓解，但停药后突然复发。随后开始第二次皮质类固醇治疗，成功诱导了疾病缓解。第二次停药 8 个月后，垂体功能恢复，垂体肿块消失，仅部分尿崩症未改变。文献回顾确定了 30 篇文章，其中包括病例报告和病例系列，共报告了 44 例自身免疫性垂体炎患者接受糖皮质激素和/或硫唑嘌呤治疗。将所有病例结合起来，医学治疗在 84%的病例中有效缩小了垂体肿块，在 45%的病例中改善了前垂体功能，在 41%的病例中恢复了后垂体功能。讨论了自身免疫性垂体炎的临床方面，并提出了该病的诊断和治疗的可能方案。
