Document Detail


Primary hypophysitis: a single-center experience in 16 cases.
MedLine Citation:
PMID:  15309917     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The authors review their experience in the treatment of 16 patients with primary hypophysitis. METHODS: A retrospective study was undertaken to review cases of primary hypophysitis. The mean age of the patients was 47 years and there was an equal distribution of sexes. Recent pregnancy and underlying autoimmunity were noted in 50% of the patients. Two patients had undergone previous transsphenoidal operations at other centers, one for prolactinoma and another for hypophysitis. Headache, anterior pituitary deficiency, and suprasellar mass lesions were the most common presenting features. The initial presumptive diagnosis was pituitary adenoma in six patients (37.5%) and inflammatory hypophysitis in 10 (62.5%). Five patients received initial medical therapy for hypophysitis; although three (60%) responded satisfactorily, two (40%) did not and later underwent surgery. Altogether 13 patients (81.2%) underwent transsphenoidal surgery. The histological diagnoses were lymphocytic hypophysitis in 10 (76.9%) and granulomatous hypophysitis in three (23.1%) of the surgically treated patients. A coexistent Rathke cleft cyst was noted in one patient. There was no death in this series. One patient experienced postoperative cerebrospinal fluid leakage and meningitis. One patient had bilateral internal carotid artery occlusion secondary to inflammatory involvement of the cavernous sinuses and arteritis. This patient recovered and is capable of independent functional activities. CONCLUSIONS: All surgical patients experienced improvement in their headache and/or visual field defects and none had visual deterioration. None of the patients experienced any improvement in endocrine function and all required long-term hormone replacement. Transsphenoidal surgery was a safe and effective treatment especially for visual and pressure symptoms. A postoperative recurrence developed in two patients (15.4%) and the treatment modalities included steroid therapy, repeated surgery, and radiosurgery.
Authors:
Gilberto K K Leung; Maria-Beatriz S Lopes; Michael O Thorner; Mary Lee Vance; Edward R Laws
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  101     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-16     Completed Date:  2004-09-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  262-71     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Giant Cell Arteritis / complications
Granulomatous Disease, Chronic / complications
Graves Disease / complications
Humans
Hydrocortisone / blood
Hypothyroidism / complications
Inflammation / pathology,  surgery
Magnetic Resonance Imaging
Male
Middle Aged
Pituitary Diseases / diagnosis*,  surgery*,  therapy
Pituitary Gland / metabolism,  pathology*,  surgery*
Pituitary Neoplasms / complications
Postoperative Complications
Prolactinoma / complications
Radiosurgery
Retrospective Studies
Steroids / therapeutic use
Chemical
Reg. No./Substance:
0/Steroids; 50-23-7/Hydrocortisone

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