China
Africa
Explore chapters and articles related to this topic
Oncological effects on the central nervous system
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Hypophysitis is an inflammatory process of the pituitary gland which manifests with headache, fatigue, dizziness, and memory impairment. Most patients also have deficiency of several anterior pituitary hormones, usually adrenocorticotropic hormone (ACTH) or thyroid stimulating hormone (TSH). Conversely, posterior pituitary function is usually preserved, as central diabetes insipidus is only infrequently reported. This compares to pituitary metastatic disease in which central diabetes insipidus is a common feature. Hypophysitis is more prevalent in association with the anti-CTLA4 drugs (e.g. ipilimumab), where it occurs in 9%–10% of patients, compared to other ICI drug groups (anti-PD1 or anti-PDL1 monoclonal antibodies such as pembrolizumab), where it occurs in <1% of patients (29). Hypophysitis tends to present 6–12 weeks after the initiation of anti-CTLA4 therapy and is more frequent in patients treated with higher doses; it affects men and women equally (30).
Pituitary and adrenal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Corticosteroids are a logical and reportedly successful treatment for lymphocytic hypophysitis, especially during pregnancy and if there is no visual disturbance (necessitating surgery). However, many cases undergo surgery because of misdiagnosis of pituitary tumour. This results in new hypopituitarism or failure of existing dysfunction to improve.
Neuroendocrine disease
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Autoimmune (lymphocytic) hypophysitis44 (Figure 1.14) is a chronic inflammatory condition that affects the anterior pituitary, posterior pituitary, or both. It has an estimated prevalence of about 9 per million. Isolated involvement of the anterior pituitary has a striking predilection for young females (female:male ratio 6:1), particularly in late pregnancy or in the postpartum period. Involvement of both the anterior and the posterior pituitary occurs about twice as commonly in females, whereas involvement of the pituitary stalk and posterior pituitary (infundibular neurohypophysitis) appears to affect males and females equally. It typically presents with headache, suprasellar pituitary mass, and hypopituitarism. Unlike pituitary adenomas, ACTH secretion is usually affected first, followed by TSH, LH, FSH, and GH and prolactin. Visual field defects are common. Diabetes insipidus occurs with involvement of the posterior pituitary and may be associated with thickening of the pituitary stalk on MRI. Failure of lactation may occur in the postpartum period. Less commonly, hyperprolactinemia may occur, as with other large pituitary tumors, presumably at least in part, due to stalk compression. An important differential diagnosis in the postpartum period is Sheehan’s syndrome42 and granulomatous conditions such as histiocytosis X and sarcoidosis (Figure 1.15). A definitive diagnosis can only be made by biopsy. If the diagnosis is considered to be a possibility and the patient is not at risk from compressive symptoms, then a conservative approach should be adopted, as in some patients the endocrine dysfunction is only transient. High-dose glucocorticoids may be considered in some cases, if interventional therapy is deemed to be necessary.
Squamous cell carcinoma of the lung: improving the detection and management of immune-related adverse events
Published in Expert Review of Anticancer Therapy, 2022
Lara Kujtan, Rama Krishna Kancha, Beth Gustafson, Lindsey Douglass, Christopher RH Ward, Blake Buzard, Janakiraman Subramanian
Hypophysitis is an uncommon IRAE, occurring in 9–11% of patients on combination ICIs and 1% of patients treated with monotherapy ICI [41]. Hypophysitis is accompanied by symptoms of headache, photophobia, dizziness, nausea, fevers, fatigue, and gonadotropin deficiency. Patients with low ACTH levels should undergo assessment of anterior pituitary function and should include testing levels of adrenocorticotropic hormone (ACTH), morning cortisol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), TSH, free thyroxine (free T4), testosterone in men and estrogen in premenopausal women. Low levels of these hormones are indicative of hypophysitis, although pituitary metastases should also be ruled out. Critically, cortisol and ACTH tests are unreliable in the patient on systemic glucocorticoids, including premedication for anti-cancer therapy. Endocrinology should be consulted for a diagnosis of hypophysitis. ICI management is based on symptoms; for acute, symptomatic hypophysitis (headache and symptoms caused by pituitary edema) hold ICI and initiate prednisone 1–2 mg/kg/day until acute symptoms resolve, typically 1–2 weeks. Taper steroids rapidly to physiologic replacement levels upon improvement. Consider resumption of ICI therapy once symptoms resolve. Physiologic hormone replacement is often required indefinitely [37–39].
Current and future immunotherapies for thyroid cancer
Published in Expert Review of Anticancer Therapy, 2018
Alessandro Antonelli, Silvia Martina Ferrari, Poupak Fallahi
Primary hypothyroidism is diagnosed if thyroid stimulating hormone (TSH) levels are increased in presence of a low free thyroxine (T4) level, whereas hypophysitis is characterized by a low TSH and low free T4. In case of primary hypothyroidism, immune checkpoint inhibitor therapy can be continued with appropriate levothyroxine replacement [42]. Hypophysitis can present as fatigue, headaches, and visual field defects. Diagnosis is established according to levels of pituitary hormones (ACTH, TSH, FSH, LH, GH, IGF-1, and prolactin) and nuclear magnetic resonance imaging showing an enlarged pituitary, with/without necrosis. For grade ≥2 toxicity, it is advised to withhold immune checkpoint inhibitor therapy and start high-dose corticosteroids (methylprednisolone 125 mg daily intravenously for 3 days with a switch to oral prednisone 1–2 mg/kg daily upon improvement of symptoms). The corticosteroid therapy (which is quite frequent in neoplastic subjects) may have a direct effect on the pituitary by reducing TSH levels. Furthermore, corticosteroid therapy can be associated with an ‘euthyroid sick syndrome’ (also known as non-thyroidal illness syndrome) characterized by low serum triiodothyronine (T3) and elevated reverse T3 (rT3). This might affect differential diagnosis when evaluating thyroid function tests [42].
Granulomatous hypophysitis in a postpartum patient: A case report
Published in Cogent Medicine, 2018
Alexey Youssef, Rahaf Ali, Maya Marouf
Hypophysitis is a rare inflammatory disorder of the pituitary gland, with an approximate incidence of one case per 9 million people per year. Based on pathological findings, it is classified into lymphocytic, granulomatous and xanthomatous hypophysitis. While lymphocytic hypophysitis LH is the most common (397 reported cases in the literature), granulomatous hypophysitis PGH comes in the second place with 85 proven cases reported in the literature (Bhansali, Velayutham, Radotra, & Pathak, 2004; Hunn et al., 2014; Joneja et al., 2016; Su, Zhang, Yue, & Zhang, 2011). Furthermore, GRH is classified into primary and secondary disorders. Secondary causes include systemic inflammatory disorders such as sarcoidosis, Wegener granulomatosis, tuberculosis and Langerhans cell histiocytosis. Unlike LH, PGH is not associated with pregnancy nor with autoimmune diseases. However, both are similar in that they have a female predilection (Hunn et al., 2014).