Abstract 46: Hypophysitis: A single centre experience on clinical, hormonal and radiological outcomes

Background Hypophysitis is diagnosed in patients with symptoms of sellar mass lesion such as headache, visual field deficits, partial or panhypopituitarism, diabetes insipidus or hyperprolactinemia. Detailed clinical history, biochemical, immunological tests, and imaging characteristics help to determine the etiology, and guide management. Objectives To characterize the clinical, hormonal and radiological profile of patients with hypophysitis presenting to a tertiary care pituitary unit, and to study the outcomes on follow up. Methods Patients with hypophysitis were recruited by retrospective chart review from 2001 to 2022 (from the computerized hospital information system). Their clinical presentation, hormonal profile and imaging characters were recorded. Response to treatment, recovery of pituitary hormonal axes and radiological changes on follow-up were recorded. Results Eighty-seven patients (56 females and 31 males) were included, of which 6 were related to pregnancy. The mean age at diagnosis was 37.9 + 11.6 years. Headache – 54 (62%), visual disturbance- 22 (25%) and polyuria -38 (44%) were the most common presenting symptoms. Systemic symptoms like fever, weight loss and asthenia were present in 31 (36%). Anterior hypopituitarism was diagnosed in 63 (72%) patients (secondary hypocortisolism - 59%, secondary hypothyroidism - 53%, and secondary hypogonadism - 61%). Hyperprolactinemia was noted in 23 patients, and 40 (46%) had diabetes insipidus (DI). Fifty-eight patients (67%) were diagnosed with primary hypophysitis (PH), 27 (31%) with secondary hypophysitis (SH) and 2 (2.3%) had drug induced hypophysitis (DH) due to PD-1 inhibitor therapy. The etiology of SH included tubercular hypophysitis in 16 patients, histiocytosis in 4, sarcoidosis in 4 and IGG4 disease in 1 patient. The median duration of follow-up were 2 years (0.2 -15 years) and 4 years (0.4-20 years) for patients with PH and SH respectively. Among PH - 38/58 (65%) received glucocorticoid therapy (high dose IV/ oral/ physiological replacement). Recovery of one or more anterior pituitary hormonal axes were noted in 26% of PH and 19% of SH. DI resolved in 8.3% and 16.7% of PH and SH respectively. Radiological improvement was noted in 89.5% of PH and 82.3% of SH. Of the 2 patients with drug induced hypophysitis, anterior pituitary axes did not recover, and neurohypophysis was not affected. Conclusion Patients with primary hypophysitis who were treated with glucocorticoids were more likely to recover their anterior pituitary hormonal axes; and their recovery was better than those with secondary hypophysitis. Radiological improvement was noted in more than 80% of patients of PH and SH.