Presentation
It typically presents with hypopituitarism and pituitary mass found by MRI. We report here unusual presentations of two females with AH followed by empty sella syndrome. [ncbi.nlm.nih.gov]
Entire Body System
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Burning Pain
Last year I also started feeling this burning pain in my liver area. I underwent lots of tests and doctors continued to tell me they couldn't find anything wrong. I am amazed to find this and others with the condition saying they have the same pain! [medhelp.org]
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HELLP Syndrome
I have a history of severe HELLP Syndrome during the birth of my child 5 yrs ago and wasn't expected to live. Haven't been the same since. [medhelp.org]
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Relapsing Polychondritis
Others such as birdshot retinochoroidopathy, autoimmune hypoparathyroidism, and relapsing polychondritis are true rarities. [doi.org]
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Gangrene
Surgery revealed an acutely inflamed, gangrenous appendix that had not ruptured. The appendix was removed, but 8 h later the patient developed circulatory shock and died. [slideplayer.com]
Gastrointestinal
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Lower Abdominal Pain
She was admitted to the hospital for vomiting, diarrhea, and severe lower abdominal pain radiating to the right iliac fossa, and thus was brought to the operating room for suspected appendicitis. [slideplayer.com]
Urogenital
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Incontinence
An 87-year-old man was admitted with fatigue, anorexia, vomiting, urinary incontinence, and a depressive state. [ncbi.nlm.nih.gov]
Neurologic
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Headache
Four years later, severe headache and a MRI suggestive of pituitary adenoma recurred. A relapse of the autoimmune phenomenon seemed the most feasible hypothesis. [ncbi.nlm.nih.gov]
Workup
Patient’s workup for possible secondary etiologies of hypopituitarism was negative. [jcdr.net]
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]
HLA Type
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HLA-DR4
HLA DR4 allele, HLA DR5 allele (DR4 DR5) Recent association found with HLA DQ8 and DR53 alleles as well Can be associated with antibody to PIT1 (POU1F1) Risk Factors Female gender Pregnancy Pregnant type 1 diabetics are at even higher risk. [unboundmedicine.com]
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HLA-DR5
HLA DR4 allele, HLA DR5 allele (DR4 DR5) Recent association found with HLA DQ8 and DR53 alleles as well Can be associated with antibody to PIT1 (POU1F1) Risk Factors Female gender Pregnancy Pregnant type 1 diabetics are at even higher risk. [unboundmedicine.com]
Treatment
Treatment and responses of these patients with autoimmune hypophysitis suggest that glucocorticoid therapy combined with azothioprine is effective treatment for recurrent autoimmune hypophysitis. [ncbi.nlm.nih.gov]
Prognosis
Germinomas have a better prognosis than NGGCTs of which chorioncarcinomas have the worst prognosis. [web.archive.org]
(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 rarity of xanthomatous hypophysitis has limited the understanding of their natural history, pathogenesis, and prognosis. The number of reported cases is also not sufficient to characterize clinical presentation. [synapse.koreamed.org]
The 3 cases in the present study that were administered high-dose methylprednisolone or levothyroxine sodium therapy demonstrated a positive prognosis. [spandidos-publications.com]
Etiology
As autoimmune etiologies were likely involved in the disorders, autoimmune hypophysitis associated with Graves' disease was arrived at as the plausible diagnosis. [ncbi.nlm.nih.gov]
Secondary hypophysitis includes the cases where a clear etiological agent can be identified (for example, the administration of immunomodulatory drugs like CTLA-4 blocking antibody), the cases where the inflammation of the pituitary is considered a reaction [jhu.pure.elsevier.com]
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. [sciencedirect.com]
Epidemiology
References 1 2003 The epidemiology of autoimmune diseases. Autoimmun Rev 2 : 119 – 125 2 1997 Epidemiology and estimated population burden of selected autoimmune diseases in the United States. [doi.org]
Less commonly affects the infundibulum or posterior pituitary, causing diabetes insipidus and hyperprolactinemia Epidemiology Predominantly seen in women: female male (5:1) Strong association with pregnancy, most frequently occurring in the gestational [unboundmedicine.com]
Epidemiology (C.N.), Neurosurgery (A.O.), Neuroradiology (M.G.P.), and Molecular Microbiology and Immunology (P.C., N.R.R.), The Johns Hopkins University, Baltimore, Maryland 21205 Diabetes and Endocrine Department, Kameda medical center Masuzawa [slideplayer.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]
Granulomatous hypophysitis, however, differs from lymphocytic hypophysitis in certain epidemiological features, which are mostly associated with pregnancy and autoimmune diseases [ 6 ]. [kjim.org]
Pathophysiology
Undiagnosed cases due to indolent disease Prevalence Uncommon Found in Etiology and Pathophysiology Most commonly caused by an autoimmune infiltration that includes an admixture of T and B lymphocytes with plasma cells Causes extrasellar pituitary enlargement [unboundmedicine.com]
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]
16 A recent report identified autoimmune antibodies against GH (growth hormone) and adrenocorticotropic hormone in a patient with IgG4-related hypophysitis. 17 Nonetheless, collecting further evident cases and analysis is required to characterize the pathophysiology [scielo.br]
The detailed pathophysiology, clinical picture, and therapy of patients with pituitary adenomas and hormone hypersecretion are discussed elsewhere and will not be discussed in this chapter. [web.archive.org]
Prevention
These cases highlight the importance of early screening and treatment for hypopituitarism in all subjects undergoing treatment with anti-CTLA-4 therapy to prevent a potentially fatal outcome from secondary adrenal insufficiency, a readily treatable disease [ncbi.nlm.nih.gov]
Patients need vigilant monitoring for cardiovascular instability. [5] Regional anesthesia with moderate doses of local anesthetic can to some extent prevent perioperative crisis due to reduction of stress response. [joacp.org]
This will make it possible to prevent delays in treatment and to avoid the consequences of hypopituitarism, particularly unreplaced adrenal insufficiency. References [1] P. Leporati, M. Landek-Salgado, I. Lupi, L. Chiovato, P. Caturegli. [elsevier.es]
ipilimumab or tremelimumab) General Prevention None Commonly Associated Conditions Aseptic meningitis: unknown if simple association or causal Other autoimmune polyendocrinopathies are the following: Hashimoto thyroiditis; Graves disease is most common [unboundmedicine.com]
The question whether early therapy with l-thyroxin in our patient might have prevented the evolution towards carcinoma will remain unanswered. [ijcasereportsandimages.com]