Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis

Introduction Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable. Objective To identify clinical and radiological findings associated with response to glucocorticoids. Design and methods 12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12–96 months). Results MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (n = 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (n = 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28% P = 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%; P = 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (P = 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (P = 0.008) but diabetes insipidus persisted in all. Conclusions Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids.

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Surgical treatment of craniopharyngiomas. Part II. Endocrine results

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.6.6 ◽

1997 ◽

Vol 3 (6) ◽

pp. E5 ◽

Cited By ~ 3

Author(s):

Jürgen Honegger ◽

Michael Buchfelder ◽

Rudolf Fahlbusch

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Complete Removal ◽

Complete Recovery ◽

Pituitary Function ◽

Pituitary Stalk ◽

Primary Surgery ◽

Anterior Pituitary Function ◽

Endocrine Axis

This study aimed to elucidate the endocrine outcome of craniopharyngioma surgery. In particular, endocrine results were analyzed in relation to the surgical approach. The study includes 161 patients who underwent pre- and postoperative endocrine assessment, 143 of whom had not previously undergone surgery. Diabetes insipidus was the most common postoperative deficiency in both the transcranial and transsphenoidal groups. In the case of primary surgery (surgery as initial therapy), the overall percentage of patients with diabetes insipidus increased from 16.1% preoperatively to 59.4% postoperatively. After transcranial surgery, the rate of anterior pituitary deficiency also increased. However, normal preoperative anterior pituitary function was maintained in more than 50% of patients for each endocrine axis. Similar results were attained in the group of patients undergoing complete tumor removal. The best result was achieved for gonadal function: the incidence of hypogonadism increased only slightly from 77.4 to 79.8%. During transsphenoidal surgery, anterior pituitary function was generally preserved. An additional deficient axis was encountered postoperatively in only four (11.4%) of 35 primary surgery cases. Endocrine results were not inferior in patients with a ventrally displaced pituitary. This variant required midline incision of the gland for exposure of the craniopharyngioma. Panhypopituitarism was encountered in only one of eight patients in whom the pituitary stalk was partially resected because of tumor infiltration. None of the 88 patients who remained recurrence-free demonstrated endocrine deterioration during follow-up review, compared with the early postoperative assessment 3 months postsurgery. On the other hand, complete recovery of one endocrine axis was observed in nine of these patients during later follow-up evaluations. In five of them, diabetes insipidus had regressed. The authors conclude that it is worth preserving the pituitary stalk and gland at surgery because anterior pituitary function is more often maintained than is generally believed. Postoperative diabetes insipidus must be accepted as a consequence of complete removal of the pituitary. However, pituitary function may recover and diabetes insipidus in particular may abate with time.

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Pituitary assessment strategy

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.2067 ◽

2011 ◽

pp. 127-136

Author(s):

W. M. Drake ◽

P. J. Trainer

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Patient Management ◽

Pituitary Function ◽

Rational Approach ◽

Posterior Pituitary ◽

Physiological Basis ◽

Assessment Strategy ◽

Anterior Pituitary Function ◽

Treatment Of Diabetes

The optimum methods of testing anterior and posterior pituitary function and the interpretation of the results are subjects of continuing debate. The syndromes associated with and consequences of hypo- and hyperpituitarism, and the diagnosis and treatment of diabetes insipidus are all discussed elsewhere in this book. The intention of this chapter is to describe the physiological basis and evidence in favour of the various available tests of anterior pituitary function, discuss the limitations of using artificial assessments on which to base patient management decisions and, ultimately, endeavour to produce a rational approach to the investigation of suspected hypopituitarism.

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Evaluation of Anterior Pituitary Function in Patients with Posttraumatic Diabetes Insipidus

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem-51-6-1279 ◽

1980 ◽

Vol 51 (6) ◽

pp. 1279-1282 ◽

Cited By ~ 25

Author(s):

TOMMASO BARRECA ◽

CARLO PERRIA ◽

ANTONELLO SANNIA ◽

GIANNI MAGNANI ◽

ERMANNO ROLANDI

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Pituitary Function ◽

Anterior Pituitary Function

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Anterior pituitary function and computed tomography/magnetic resonance imaging in patients with langerhans cell histiocytosis and diabetes insipidus

Medical and Pediatric Oncology ◽

10.1002/mpo.2950210908 ◽

1993 ◽

Vol 21 (9) ◽

pp. 649-654 ◽

Cited By ~ 35

Author(s):

Valerie Broadbent ◽

David B. Dunger ◽

Elizabeth Yeomans ◽

Brian Kendall

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Diabetes Insipidus ◽

Anterior Pituitary ◽

Langerhans Cell Histiocytosis ◽

Langerhans Cell ◽

Pituitary Function ◽

Resonance Imaging ◽

Anterior Pituitary Function

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Meningoencephalitis Complicated by Pituitary Insufficiency and a Spontaneously Resolving Suprasellar Mass

Neurosurgery ◽

10.1227/00006123-198405000-00008 ◽

1984 ◽

Vol 14 (5) ◽

pp. 567-569 ◽

Cited By ~ 7

Author(s):

Katherine Jew ◽

Veronica Piziak ◽

Paul F. Gilliland ◽

Douglas L. Hurley

Keyword(s):

Antibiotic Therapy ◽

Diabetes Insipidus ◽

Anterior Pituitary ◽

Pituitary Function ◽

Pituitary Insufficiency ◽

Posterior Pituitary ◽

Bacterial Origin ◽

Anterior Pituitary Function

Abstract A 53-year-old woman presented with acute meningoencephalitis associated with anterior and posterior pituitary insufficiency. A computed axial tomogram (CT) of the head revealed a suprasellar mass. The meningoencephalitis, presumably of bacterial origin, resolved after antibiotic therapy and, on a repeat CT, the suprasellar mass had disappeared. Five months after the initial illness, the patient's diabetes insipidus had resolved, anterior pituitary function had improved, and there was no sign of the suprasellar mass. The presence of a suprasellar mass in conjunction with acute meningoencephalitis and anterior and posterior pituitary insufficiency should raise the suspicion that the mass is not neoplastic and may be infectious or inflammatory in origin.

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SUN-282 Transient Infundibulohypophysitis in a Child with Central Diabetes Insipidus

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.693 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Shabana Kalladi Puthanpurayil ◽

Ahsan Uddin ◽

Peter Matthew Gerrits

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Elevated Serum ◽

Central Diabetes Insipidus ◽

Pituitary Stalk ◽

Bright Spot ◽

Neoplastic Process ◽

Anterior Pituitary Function ◽

History Of ◽

Pituitary Stalk Thickening

Abstract Case Description A 7-year-old previously healthy female presented with a 1-month history of tiredness, excessive thirst and increased urinary frequency. Initial studies showed an elevated serum osmolality with relatively dilute urine. She underwent a water deprivation study which confirmed central diabetes insipidus (CDI). An MRI of the brain was obtained which showed markedly thickened and homogeneously enhancing pituitary stalk thickening (17mm craniocaudal x10 mm anteroposterior diameter). Workup did not reveal any signs suggestive of Langerhan’s cell histiocytosis; a skin biopsy and bone survey were normal. A pituitary stalk biopsy was scheduled, however direct endoscopic visualization of the pituitary stalk was normal, so the procedure was aborted. A repeat MRI 7 weeks later showed complete resolution of the stalk thickening. An MRI done 4 months later again showed normal anterior pituitary and normal pituitary stalk, with persistent absent posterior bright spot. She remains on desmopressin, and anterior pituitary functions have been normal to date. Discussion CDI in children can be due to infectious, neoplastic, traumatic or genetic processes that disrupt the hypothalamus or pituitary stalk. One third of children with CDI present with pituitary stalk thickening (PST) on initial evaluation with MRI. There are wide variations in the degree of PST. Previous studies have shown that the degree of PST is different depending on the underlying etiology. Furthermore, regression of PST has been observed in many cases of CDI with PST which has been attributed to idiopathic or autoimmune process (infundibulohypophysitis). Most studies have demonstrated that PST > 4 mm is unlikely to regress and may be more likely to progress with eventual diagnosis of a neoplastic process such as germinoma or Langerhan’s cell histiocytosis. Based on review of the literature, the earliest resolution of PST was in 3 months in a patient who received steroid therapy at diagnosis. [1] Conclusion Our case illustrates that in children with central diabetes insipidus, isolated pituitary stalk thickening may resolve in as short a period as 7 weeks. While ongoing evaluation is warranted with serial pituitary imaging, unnecessary invasive procedures may be avoided in patients without evidence of other underlying anatomic pathology. Anterior pituitary function requires initial and continued surveillance. References 1. Shaefers J et al. Clinical presentation and outcome of children with central diabetes insipidus associated with a self-limited or transient pituitary stalk thickening, diagnosed as infundibuloneurohypophysitis. Clin Endocrinol (Oxf). 2017 Aug;87(2):171-176. doi: 10.1111/cen.13362. Epub 2017 Jun 5.

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