Evaluation and follow-up of patients diagnosed with hypophysitis: a cohort study.
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Hacioglu Aysa, Karaca Zuleyha, Uysal Serhat, Ozkaya Hande Mefkure, Kadioglu Pınar, Selcukbiricik Ozlem Soyluk, Gul Nurdan, Yarman Sema, Koksalan Damla, Selek Alev, Canturk Zeynep, Cetinarslan Berrin, Corapcioglu Demet, Sahin Mustafa, Sah Unal Fatma Tugce, Babayeva Afruz, Akturk Mujde, Ciftci Sema, Piskinpasa Hamide, Dokmetas Hatice Sebile, Dokmetas Meric, Sahin Onur, Eraydın Ayten, Fenkci Semin, Ozturk Sadettin, Akarsu Ersin, Omma Tulay, Erkan Buruc, Burhan Sebnem, Pehlivan Koroglu Esma, Saygili Fusun, Kilic Kan Elif, Atmaca Aysegul, Elbuken Gulsah, Alphan Uc Ziynet, Gorar Suheyla, Hekimsoy Zeliha, Pekkolay Zafer, Bostan Hayri, Bayram Fahri, Yorulmaz Goknur, Sener Selcuk Yusuf, Turan Kubra, Celik Ozlem, Dogruel Hakan, Ertorer Eda, Turhan Iyidir Ozlem, Topaloglu Omercan, Cansu Guven Baris, Unluhizarci Kursad, Kelestimur Fahrettin
Аннотация
DESIGN: A retrospective observational study.
METHODS: The demographic, clinical, and radiologic features and follow-up data were collected in study protocol templates and analyzed.
RESULTS: One hundred and thirteen patients (78.8% female, median age: 36 years) were included. Lymphocytic (46.7%) and granulomatous hypophysitis (35.6%) were the prevailing subtypes out of 45 patients diagnosed after pathologic investigations. Headache (75.8%) was the most common symptom, and central hypogonadism (49.5%) was the most common hormone insufficiency. Of the patients, 52.2% were clinically observed without interventions, 18.6% were started on glucocorticoid therapy, and 29.2% underwent surgery at presentation. Headache, suprasellar extension, and chiasmal compression were more common among glucocorticoid-treated patients than who were observed. Cox regression analysis revealed higher hormonal and radiologic improvement rates in the glucocorticoid-treated group than observation group (hazard ratio, 4.60; 95% CI, 1.62-12.84 and HR, 3.1; 95% CI, 1.40-6.68, respectively). The main indication for surgery was the inability to exclude a pituitary adenoma in the presence of compression symptoms, with a recurrence rate of 9%.
CONCLUSION: The rate of spontaneous improvement might justify observation in mild cases. Glucocorticoids proved superior to observation in terms of hormonal and radiologic improvements. Surgery may not be curative and might be considered in indeterminate, treatment-resistant, or severe cases.