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Preparation of Mouse Pituitary Immunogen for the Induction of Experimental Autoimmune Hypophysitis
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IgG4-related hypophysitis: a retrospective cohort study.

R Bhargava1, Z Hussein2,3, N L Dorward4

  • 1Department of Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK. raghavbhargava90@gmail.com.

Acta Neurochirurgica
|May 9, 2022
PubMed
Summary

IgG4-related hypophysitis (IgG4-RH) is a rare pituitary inflammation. This study highlights IgG4-RH presentation, management via surgery, and outcomes, emphasizing biopsy for diagnosis.

Keywords:
HypophysitisHypopituitarismIgG4Pituitary biopsy

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Area of Science:

  • Endocrinology
  • Immunology
  • Pathology

Background:

  • IgG4-related hypophysitis (IgG4-RH) is a rare chronic inflammatory condition affecting the pituitary gland.
  • Its clinical presentation can mimic other forms of hypophysitis, necessitating a high index of suspicion.

Purpose of the Study:

  • To report the clinical presentation, management strategies, and outcomes of patients with histologically confirmed IgG4-related hypophysitis.
  • To emphasize the importance of pituitary biopsy for accurate diagnosis and guiding further management.

Main Methods:

  • A 14-year prospective database search (2007-2020) at a single academic center identified patients with histological IgG4-RH.
  • Retrospective case note review extracted data on presentation, treatment, and outcomes.

Main Results:

  • Eight patients (median age 51 years) were identified, with headache, fatigue, and visual impairment as common symptoms.
  • All patients ultimately underwent transsphenoidal surgery, achieving radiological reduction in pituitary mass and partial visual improvement.
  • Post-surgical outcomes included persistent hypopituitarism in 50% and panhypopituitarism with diabetes insipidus in 37.5%.

Conclusions:

  • IgG4-related hypophysitis is an emerging diagnosis with varied presentations.
  • Pituitary biopsy is crucial for diagnosis, guiding workup for IgG4-related disease and multidisciplinary management.