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Conservative management effective for primary hypophysitis
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Unless symptoms are severe or progressive, conservative management is the recommended choice for primary hypophysitis, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
Further, surgery does not prevent recurrence, and glucocorticoid pulse therapy was associated with a high recurrence rate, according to findings of a retrospective cross-sectional cohort study conducted by the Pituitary Working Group of the German Society of Endocrinology.
Jürgen Honegger, MD, of the department of neurosurgery at the University of Tübingen, Germany, and colleagues evaluated data from 76 patients with primary hypophysitis to determine clinical and endocrinologic outcomes, adverse effects and complications of therapy, initial response to therapy and recurrence rates.
On MRI, 46% of space-occupying lesions regressed at least partially, 27% remained unchanged and 27% progressed, researchers found.
Twenty-seven percent of participants had improved pituitary function during follow-up, 55% remained stable and 18% deteriorated.
Glucocorticoid pulse therapy was administered to 32 participants. Twelve participants reported one or more adverse effects (Cushing’s syndrome, n = 3; increasing body weight without Cushing’s syndrome, n = 7; psychiatric symptoms, n = 2; edema, n = 1; diabetes mellitus, n = 1 and glaucoma, n = 1). Follow-up data, including MRI, were available for 29 participants and revealed that 19 had a regression in lesion size, lesion size remained stable in nine and progressed in only one; this revealed a failure rate of 41%. Twenty-six participants had available endocrine follow-up data revealing that pituitary function was unchanged in 70% during glucocorticoid administration, 15% improved and 15% had deteriorated function
Pituitary surgery was performed in 33 participants at some stage of disease. Follow-up data, including MRI, were available for 28 participants; 68% had a smaller space-occupying lesion; the lesion was unchanged in 21% and progressed in 11%. Twenty-five participants had available endocrine follow-up revealing that pituitary function was mostly unchanged (n = 17), whereas it improved in two participants and deteriorated in six participants.
“In conclusion, we have performed a nationwide retrospective study on treatment practice of [primary hypophysitis] in Germany,” the researchers wrote. “The high number of cases allows comparison of outcome of the principal treatment options. Observation is recommended unless severe or progressive symptoms emerge. Glucocorticoid therapy is initially effective, but the rates of adverse effects and relapse are worrying. Surgery is indicated for clarifying the differential diagnosis and for acute relief of local symptoms. Doubts remain whether surgery is able to halt the natural progression of [primary hypophysitis]. The results of the study might influence the current practice of treating hypophysitis.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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