An inflammation of the pituitary gland.
Defined as the dysfunction of the pituitary gland with resultant hormone deficiencies, specifically, secondary adrenal insufficiency, and primary thyroid dysfunction.
Symptoms and signs: Most commonly, the initial symptoms are headaches and visual disturbances, hyponatremia, with or without pituitary enlargement and rarely are symptoms related to mass effect.
Patients may present with neuro psychiatric symptoms such as confusion, memory loss, hallucinations, labile mood, anorexia, nausea, diarrhea, cold intolerance, decreased libido, or erectile dysfunction.
Some patients with hypophysitis can present with signs of adrenal crisis.
Diagnoses should be suspected when patients present with central hypothyroidism showing low free thyroxine and low or inappropriately low normal TSH.
Some symptoms appear due to decreased functioning of the adenohypophyseal hormones.
Adversely affected cells of the anterior pituitary are: corticotropes, lactotropes and gonadotropes.
Polyuria and polydipsia are common.
Hyperprolactinemia, can occur.
It may have an underlying autoimmune etiology, as in the case of autoimmune hypophysitis, and lymphocytic hypophysitis.
Most accurate diagnosis uses Magnetic Resonance Imaging (MRI) to find any mass or lesions on the sella turcica.
It is a known side-effect of immune checkpoint inhibitors of the CTLA-4 inhibitor and PD-L1 inhibitor classes.
Meta-analysis reports frequency of hypophysitis of 6.4 percent with combination immune checkpoint inhibitors, 3.2% with CTLA- 4 inhibitor monotherapy and less than 1% with PD-1/PD-L1 inhibitor monotherapy.
Bromocriptine can improve field of vision defects and lower prolactin levels.
Corticosteroids, can decrease the size of the gland, and relieve compression on the dura mater.
The prognosis depends factors on the the advancement of the mass on the sella turcica, percentage of fibrosis, and the body’s response to corticosteroids.
Prognoses of reported cases were usually good.