Division of Endocrinology, Indiana University, Indianapolis, Indiana.
Department of Neurosurgery, University of Tübingen, Tübingen, Germany.
Endocr Pract. 2022 Sep;28(9):901-910. doi: 10.1016/j.eprac.2022.06.009. Epub 2022 Jun 30.
Hypophysitis is considered a rare inflammatory disease of the pituitary gland. For a long time, primary autoimmune hypophysitis has stood out as the most relevant type of hypophysitis. However, with the advent of immunotherapy for the treatment of malignancies and identification of hypophysitis as an immune-related adverse event, hypophysitis has garnered increasing interest and recognition. Therefore, awareness, early recognition, and appropriate management are becoming important as the indication for immunomodulatory therapies broaden.
In this review, we discuss the epidemiology, diagnosis, and treatment of hypophysitis with a focus on recent data and highlight subtypes of particular interest while recognizing the gaps in knowledge that remain.
Regardless of cause, symptoms and signs of hypophysitis may be related to mass effect (headache and visual disturbance) and hormonal disruption that warrant prompt evaluation. In the vast majority of cases, a diagnosis of hypophysitis can be made presumptively in the appropriate clinical context with radiologic findings consistent with hypophysitis and after the exclusion of other causes.
Although subtle differences currently exist in management and outcome expectations between primary and secondary causes of hypophysitis, universally, treatment is aimed at symptom management and hormonal replacement therapy.
垂体炎被认为是一种罕见的垂体炎症性疾病。长期以来，原发性自身免疫性垂体炎一直是最相关的垂体炎类型。然而，随着免疫疗法治疗恶性肿瘤的出现以及将垂体炎确定为一种免疫相关的不良反应，垂体炎越来越受到关注和认可。因此，随着免疫调节治疗的适应证不断扩大，提高认识、早期识别和适当管理变得越来越重要。
在这篇综述中，我们讨论了垂体炎的流行病学、诊断和治疗，重点是最近的数据，并强调了特别关注的亚型，同时认识到仍然存在知识空白。
无论病因如何，垂体炎的症状和体征可能与肿块效应（头痛和视力障碍）和激素紊乱有关，这需要进行及时评估。在绝大多数情况下，可以根据适当的临床情况、符合垂体炎的影像学发现，并排除其他原因，做出垂体炎的推测性诊断。
尽管原发性和继发性垂体炎的治疗和预后预期存在细微差异，但普遍的治疗目标是症状管理和激素替代治疗。
