Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana 46206, USA.
Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Clin Endocrinol Metab. 2022 Mar 24;107(4):1170-1190. doi: 10.1210/clinem/dgab839.
Lymphocytic hypophysitis (LyHy) is characterized by inflammation of the pituitary and or neuroinfundibulum and is uncommon. Treatment options include observation, high-dose glucocorticoids (HD-GCs) or surgery. Optimal first-line management strategy, however, remains unknown.
This work aimed to assess response to first-line treatment options (observation, HD-GCs, or surgery) of clinically relevant outcomes (symptomatic, hormonal, and radiographic improvement) among patients with LyHy.
A systematic review was conducted in 6 databases through 2020. Meta-analysis was conducted when feasible using a random-effects model.
We included 33 studies reporting on 591 patients (423 women, 72%) with LyHy. Improvement/resolution of anterior pituitary dysfunction was highest when HD-GCs was first-line treatment. Surgery was associated with the greatest proportion of patients who had regression on imaging. Subgroup analysis comparing HD-GCs to observation showed the odds of anterior pituitary hormone recovery (OR 3.41; 95% CI, 1.68-6.94) or radiographic regression (OR 3.13; 95% CI, 1.54-6.36) were higher with HD-GCs, but so was the need for additional forms of treatment (OR 4.37; 95% CI, 1.70-11.22). No statistically significant difference was seen in recovery of diabetes insipidus (OR 0.9; 95% CI, 0.26-3.10). Certainty in these estimates was very low.
Observation and use of HD-GCs both are successful first-line management strategies in LyHy. Although use of HD-GCs was associated with increased recovery of anterior pituitary hormone deficit, it also was associated with greater likelihood of additional treatment after withdrawal. Optimal dosing and duration of HD-GCs remains unknown.
淋巴细胞性垂体炎（LyHy）的特征是垂体和/或神经漏斗的炎症，较为罕见。治疗选择包括观察、大剂量糖皮质激素（HD-GCs）或手术。然而，最佳的一线治疗策略尚不清楚。
本研究旨在评估 LyHy 患者的一线治疗选择（观察、HD-GCs 或手术）对临床相关结局（症状、激素和影像学改善）的反应。
通过 2020 年的 6 个数据库进行系统评价。当可行时，使用随机效应模型进行荟萃分析。
我们纳入了 33 项研究，共报告了 591 例 LyHy 患者（423 例女性，72%）。当 HD-GCs 作为一线治疗时，改善/解决垂体前叶功能障碍的比例最高。手术与影像学上最大比例的患者肿瘤消退相关。与观察相比，HD-GCs 与手术的比较显示，前垂体激素恢复的可能性（OR 3.41；95%CI，1.68-6.94）或影像学消退的可能性（OR 3.13；95%CI，1.54-6.36）更高，但需要额外的治疗形式（OR 4.37；95%CI，1.70-11.22）的可能性也更高。糖尿病性尿崩症的恢复没有统计学差异（OR 0.9；95%CI，0.26-3.10）。这些估计的确定性非常低。
观察和使用 HD-GCs 都是 LyHy 的成功一线治疗策略。虽然使用 HD-GCs 与前垂体激素缺乏症的恢复增加有关，但也与停药后更有可能需要额外的治疗有关。HD-GCs 的最佳剂量和持续时间仍不清楚。
