Presentation
The lymphocyte subsets present in the infiltrate were characterized by immunohistochemical methods to establish the contribution of different elements of the cellular immune response. [ncbi.nlm.nih.gov]
Entire Body System
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Swelling
In obtaining a differential diagnosis of lymphocytic adenohypophysitis preoperatively, it is useful to note swelling of the anterior hypophyseal tissue and the existence of a posterior pituitary lobe on sagittal sections of magnetic resonance imaging [ncbi.nlm.nih.gov]
The axons run from the supraoptic and paraventricular hypothalamic nuclei and have swellings called neurosecretory (Herring) bodies (NB) from which either oxytocin or vasopressin is released upon neural stimulation. [de.slideshare.net]
One case showed swelling of the posterior pituitary gland. Among all patients ( n 22), an abnormally thickened infundibular stalk was found in 17 patients, and loss of T1 hyperintensity in the posterior lobe was seen in 18 patients. [e-enm.org]
There are some reported cases presenting with swelling of the whole pituitary gland and stalk with no appreciable anterior pituitary dysfunction. [asean-endocrinejournal.org]
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Physician
LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to describe the given clinical features of lymphocytic hypophysitis, conduct a differential diagnosis, and select the appropriate treatments for patients with lymphocytic [ncbi.nlm.nih.gov]
Springer Science & Business Media, ١٤/٠٥/٢٠٠٣ - 318 من الصفحات Leading physicians from a variety of medical specialties summarize their clinical experiences in treating pituitary adenomas in United States and the United Kingdom. [books.google.com]
The true prevalence of LYH is underestimated probably because of poor recognition of this disorder by physicians. Early diagnosis is essential because untreated disease can be fatal. [journals.lww.com]
*Medscape Business of Medicine Academy Survey, September 2015 Learn from Experienced Professionals Courses were developed especially for physicians by business health experts and experienced physicians. [medscape.com]
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Hypothermia
Practitioners should keep in mind the possibility of lymphocytic adenohypophysitis in any pregnant women with symptoms of hypoglycemia and hypothermia after delivery. [ncbi.nlm.nih.gov]
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Cold Intolerance
A 47-year-old woman complaining of cold intolerance, general weakness and amenorrhea of 10 months duration was diagnosed, by endocrine examinations, as having panhypopituitarism. [ncbi.nlm.nih.gov]
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Unconsciousness
An unconscious, 29-year-old woman was taken to hospital where, 28 hours after admission, she succumbed to an intractable shock. Autopsy disclosed a lymphocytic adenohypophysitis (LAH). [ncbi.nlm.nih.gov]
Eyes
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Hemianopsia
She had diabetes insipidus and bitemporal hemianopsia. Radiological evidence suggested a mass arising in the sella turcica with extension into the parasellar and suprasellar regions. [ncbi.nlm.nih.gov]
Source MeSH Adult Antibodies, Antinuclear Female Hemianopsia Humans Hypopituitarism Inflammation Lymphocytes Pituitary Diseases Pituitary Function Tests Pituitary Gland, Anterior Pregnancy Pregnancy Complications Pub Type(s) Case Reports English Abstract [unboundmedicine.com]
Compression of the pituitary gland itself may cause hypopituitarism, and compression of the optic chiasm results in bitemporal hemianopsia. Headache is also a common symptom of pituitary tumors. [emedicine.medscape.com]
Bitemporal hemianopsia accounts for the majority of visual symptoms, with impaired acuity and diplopia being relatively uncommon. Endocrine dysfunction has been reported in up to 80% of cases. [surgicalneurologyint.com]
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Visual Impairment
Repeated CT performed three months after delivery showed that the pituitary mass had undergone a spontaneous regression in size, and her visual impairment improved. [unboundmedicine.com]
With mass effect and dural irritation, headache, and visual impairment have been reported in up to 50–70% of cases. Bitemporal hemianopsia accounts for the majority of visual symptoms, with impaired acuity and diplopia being relatively uncommon. [surgicalneurologyint.com]
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Blurred Vision
A 45-year-old female presented with blurred vision, headache, and abnormal thirstiness. She was not pregnant nor postpartum. She had diabetes insipidus and bitemporal hemianopsia. [ncbi.nlm.nih.gov]
Psychiatrical
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Suggestibility
None of the other known causes of galactorrhea was present suggesting that this may be a new addition to the differential diagnosis of galactorrhea. [ncbi.nlm.nih.gov]
This case suggests that some patients with postpartum hypopituitarism suggestive of lymphocytic adenohypophysitis, and with pituitary mass need not have early surgical intervention but may be closely observed and treated by hormone replacement alone. [unboundmedicine.com]
Breast
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Nipple Discharge
discharge * Amenorrhea * Left temporal mon- ocular anopsia PRL: 96 * suprasellar ext. 28 5 * Headache normal * 1.5x2.5cm contrast-enhancing lesion * suprasellar ext with chiasmatic compression TSH: Thyroid stimulating hormone FTI: Free Thyroid Index [medschool.lsuhsc.edu]
Neurologic
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Bitemporal Hemianopsia
She had diabetes insipidus and bitemporal hemianopsia. Radiological evidence suggested a mass arising in the sella turcica with extension into the parasellar and suprasellar regions. [ncbi.nlm.nih.gov]
Compression of the pituitary gland itself may cause hypopituitarism, and compression of the optic chiasm results in bitemporal hemianopsia. Headache is also a common symptom of pituitary tumors. [emedicine.medscape.com]
Bitemporal hemianopsia accounts for the majority of visual symptoms, with impaired acuity and diplopia being relatively uncommon. Endocrine dysfunction has been reported in up to 80% of cases. [surgicalneurologyint.com]
Urogenital
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Oligomenorrhea
Oligomenorrhea newly appeared during the study in three patients, although no other symptoms appeared. Serum fT3 and fT4 levels were within the reference ranges, and serum TSH level and its response to TRH stimulation remained low in all patients. [ncbi.nlm.nih.gov]
Workup
Autoimmune workup did not reveal any abnormality with CRP - 1.2 mg/l (normal 7 mg/l); antinuclear antibodies ( 1:40), and antineutrophilic cytoplasmic antibodies ( 1:16), anti-TPO Ab - 4 IU/l ( 9), RA factor 4 IU/l ( 20), and anti-TTG Ab- 3.54 IU/ ml [ijem.in]
Other Pathologies
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Lymphocytic Infiltrate
The removed tissue had histological features consistent with adenohypophysitis including a diffuse lymphocytic infiltrate. [ncbi.nlm.nih.gov]
Treatment
Treatment with supraphysiologic doses of prednisone resulted in clinical and radiographic improvement. [ncbi.nlm.nih.gov]
To round out the clinician's understanding of the illness, a patient describes the experience of diagnosis, treatment, and follow-up. [books.google.com]
Prognosis
(Gd) can variably enhance, usually homogeneously 7 dural enhancement may be present 8 infundibulum may be thickened 8 T2 hypointensity in parasellar region can be present and may be useful in differentiating from a pituitary adenoma 4 Treatment and prognosis [radiopaedia.org]
The histogenesis and prognosis of these tumours remain uncertain and need to be documented more thoroughly in the literature. [jmedicalcasereports.biomedcentral.com]
Until a specific pituitary antibody for this disease or a characteristic radiographic feature, as by MR spectroscopy, has been identified, the clinical diagnosis of this entity must rely on the histologic study of the pituitary Therapy and Prognosis The [pituitaryadenomas.com]
Etiology
We report 2 further cases and review the etiology, immunology and pathology of the disease. [ncbi.nlm.nih.gov]
Abstract Autoimmune hypophysitis, often referred to as lymphocytic hypophysitis, is defined as an inflammatory condition of the pituitary gland of autoimmune etiology that leads to pituitary dysfunction. [scititles.com]
Conclusion: Infundibuloneurohypophysitis should be taken into account in the etiological diagnosis of hypopituitarism, particularly if it is associated with diabetes insipidus and in cases of growth hormone deficit, secondary hypogonadism, or multiple [karger.com]
It was reasonably assumed, therefore, that this disease has an auto immune etiology. [pituitaryadenomas.com]
Lymphocytic hypophysitis is a primary inflammatory disorder that typically presents during or shortly after pregnancy. [30] Although of unknown etiology, lymphocytic hypophysitis is believed to be caused by an autoimmune process. [emedicine.medscape.com]
Epidemiology
[…] throughout the day and in response to metabolic factors, making abnormal levels difficult to calibrate—further hampering diagnosis. [8] [9] [10] [11] [12] [13] Treatment [ edit ] Inflammation resolves usually after several months of glucocorticoid treatment Epidemiology [en.wikipedia.org]
National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, via contract number N01-CN-67006, with Emory University, Atlanta SEER Cancer Registry, Atlanta, Georgia, U.S.A. [histology-world.com]
In this review, we provide an overview of the epidemiology, diagnosis, pathogenesis, treatment, and the role of organ-specific and antipituitary antibodies as potential markers of LYH. [clinsci.org]
The early observation suggested the possibility of a spectrum of progression starting with LYH and progressing to GH.[ 25 ] In contrast, other authors cited key epidemiological factors of LYH that were not found in GH including female bias, association [surgicalneurologyint.com]
Epidemiology The annual incidence of hypophysitis is estimated to be 1 in 7–9 million. [clindiabetesendo.biomedcentral.com]
Pathophysiology
Discrimination between these two conditions is of importance since, despite the similarity of their presentation, there are significant differences in pathophysiology. [ncbi.nlm.nih.gov]
[…] of strokes and degenerative diseases * Includes analysis of the role of the brain in the adaptive responses to disease * Evaluates the argument that further knowledge of the influence of the brain on the immune system will provide new insights to the pathophysiology [books.google.de]
Pathophysiology: The occurrence of pituitary inflammation associated with pregnancy is felt to be secondary to the involution of the pituitary gland that takes place during this time (4,7). [medschool.lsuhsc.edu]
The pathophysiologic process apparently begins as an acute inflammatory response with enlargement of the gland, as noted in 95% tissue-documented cases. [pituitaryadenomas.com]
Prevention
Cortisol inhibits the release of CRH and ACTH from the hypothalamus and pituitary gland respectively, preventing further cortisol release. Cortisol is inactivated in the liver to inactive cortisone. [endocrinesurgeon.co.uk]
During an operation, neurosurgeons typically drain these cysts early, to prevent their potential rupture and consequent chemical meningitis. [neupsykey.com]
Miyai K (2007) Congenital thyrotropin deficiency—from discovery to molecular biology, postgenome and preventive medicine. Endocr J 54 : 191–203 47. [nature.com]
Yoon JW, Choi DS, Liang HC, Baek HS, Ko IY, et al. (1992) Induction of an organ-specific autoimmune disease, lymphocytic hypophysitis, in hamsters by recombinant rubella virus glycoprotein and prevention of disease by neonatal thymectomy. [omicsonline.org]