Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
Exp Clin Endocrinol Diabetes. 2021 Mar;129(3):234-240. doi: 10.1055/a-1163-7304. Epub 2020 Aug 7.
Clinical data on primary hypophysitis are still scarce. Especially non-surgical cases are underreported. We sought to analyse clinical characteristics of primary hypophysitis, particularly in clinically diagnosed patients.
Retrospective single centre study in 60 patients with primary hypophysitis.
Symptoms, MRI, histopathological findings, treatment and outcomes were analysed in 12 histopathologically and 48 clinically diagnosed patients. Diagnostic criteria for clinical diagnosis were: a) MRI findings compatible with primary hypophysitis; b) course of disease excluding other differential diagnoses. Mean duration of follow-up was 69 months.
Female sex was predominant (73%). Fatigue (52%), headache (38%) and diabetes insipidus (38%) were the most frequent symptoms. 42% had a concomitant autoimmune disease. The corticotropic, thyrotropic, gonadotropic, somatotropic axis was impaired in 67%, 57%, 52%, 20%, respectively. Men had a higher number of impaired hormone axes (p=0.022) with the gonadotropic axis being affected more frequently in men (p=0.001). Infundibular thickening (56%) and space occupying lesions (46%) were typical MRI findings. Pituitary size was frequently enlarged at presentation (37%) but diminished during observation (p=0.029). Histopathologically and clinically diagnosed cases did not differ.
The cohort of clinically diagnosed patients did not differ from our histopathologically diagnosed patients or from published cohorts with predominantly surgical patients. Thus, diagnosis of primary hypophysitis using clinical criteria seems feasible.
原发性垂体炎的临床数据仍然很少。特别是非手术病例报道较少。我们旨在分析原发性垂体炎的临床特征，特别是在临床诊断的患者中。
在 60 例原发性垂体炎患者中进行回顾性单中心研究。
分析了 12 例组织病理学诊断和 48 例临床诊断患者的症状、MRI、组织病理学发现、治疗和结局。临床诊断的诊断标准为：a）MRI 结果符合原发性垂体炎；b）排除其他鉴别诊断的病程。平均随访时间为 69 个月。
女性占优势（73%）。疲劳（52%）、头痛（38%）和尿崩症（38%）是最常见的症状。42%的患者同时患有自身免疫性疾病。皮质激素、甲状腺刺激素、促性腺激素和生长激素轴分别有 67%、57%、52%和 20%受到损害。男性的激素轴受损数量更多（p=0.022），男性的促性腺激素轴更常受到影响（p=0.001）。漏斗增厚（56%）和占位性病变（46%）是典型的 MRI 发现。垂体大小在就诊时常增大（37%），但在观察期间缩小（p=0.029）。组织病理学和临床诊断病例无差异。
临床诊断的患者队列与我们的组织病理学诊断患者或主要为手术患者的已发表队列没有差异。因此，使用临床标准诊断原发性垂体炎似乎是可行的。
