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Abstract:
Context: The best treatment of primary hypophysitis (PrHy) is a matter
of debate.
Objective: Our main objective was to analyze the treatment practice for
PrHy in Germany and to compare the outcome of the main treatment
options.
Design: The Pituitary Working Group of the German Society of
Endocrinology conducted a nationwide retrospective cross-sectional
cohort study.
Patients: Seventy-six patients with PrHy were eligible for the study.
Main Outcome Measures: Clinical and endocrinological outcomes, side
effects and complications of therapy, initial response, and recurrence
rates were assessed. Outcome depending on the treatment modality was
evaluated.
Results: For mere observation, regression of space-occupying lesions was
observed in 46%, unchanged size in 27%, and progression reported in 27%.
Pituitary function improved in 27% of patients during observation.
Deterioration of pituitary function was only found in patients with
progressive lesions. The initial response to glucocorticoid pulse
therapy was most favorable, with early failure in only 3%. However, the
overall failure and recurrence rate was 41%. Recurrence rate was not
related to duration of steroid administration. Side effects of steroids
occurred in 63%. The surgical approach was transsphenoidal in 94%. The
histological subtype was lymphocytic hypophysitis in 70% and
granulomatous hypophysitis in 30%. Progression or recurrence was
observed in 25% after surgical treatment.
Conclusion: Glucocorticoid pulse therapy is associated with a high
recurrence rate. Evidence suggests that surgery is not able to prevent
recurrence. Considering the favorable results of observation,
conservative management is recommended in PrHy unless symptoms are
severe or progressive.
