Predictors of response to steroid therapy in primary anterior or pan-hypophysitis

Y. Chauhan*a (Dr), S. Misraa (Dr), J. Gadaa (Dr), P. Varthakavia (Dr), N. Bhagwata (Dr)

a Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, INDIA

* yashvchauhan@hotmail.com

Introduction: Recent literature suggests that, in primary hypophysitis, steroids are preferred only for mass symptoms or visual deficits. We aimed to find predictors of response at 1 year after steroid therapy.

Methods: This retrospective study (2008 to 2021) included patients with anterior or pan-hypophysitis while excluding isolated infundibuloneurohypophysitis or secondary hypophysitis. Hormonal and radiological outcomes were assessed at 1 year after steroid therapy and responses classified as “improvement” (defined as improvement in at least one radiological/hormonal parameter without worsening of any other) or “not improved” (stable or worsened). Predictors were compared using univariate and logistic regression analysis.

Results: Twenty-three patients (73.9% females, mean age 38 years) were analyzed. Sixteen patients (Group A) were treated with steroids. Seven patient (Group B) were only observed. Overall, 81%(13/16) patients improved in Group A as compared to 28.6%(2/7) patients in Group B (P=0.0147). In Group A, 62.5%(10/16) and 75%(12/16) patients showed hormonal and radiological improvement, respectively; whereas 37.5%(6/16) and 25%(4/16) remained hormonally and radiologically stable, respectively. No patient worsened. On both univariate and logistic regression analysis, predictors of hormonal improvement were symptom onset ≤6 months (83.3% vs 0%, P=0.0029), pituitary volume ≤2cm3 (70% vs 16.6%, P=0.0389) and absence of stalk thickening (50% vs 0%, P=0.0367). Predictors of radiological improvement were symptom onset ≤6 months (91% vs. 25%, P=0.007) and presence of central hypocortisolism (83.3% vs 25%, P=0.0293). There was no difference between those who received intravenous(n=10) or oral steroids(n=6) (P=0.732/P=0.551 for hormonal/radiological response, respectively). In Group B, both patients who improved had preserved cortisol axis.

Discussion: Symptom onset ≤6 months would correspond to ongoing inflammation before fibrosis sets in. The presence of hypocortisolism may be a worse outcome predictor, affirming the theory that cortisol may limit pituitary inflammation. Stalk thickness and the pituitary volume reflect degree of inflammation in the pituitary.

Bibliography:

  1. Langlois, F. et al. Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease. JCEM. 2022;107(1):10-28.
  2. Chiloiro, S. et al. Hypophysitis outcome and factors predicting responsiveness to glucocorticoid therapy: A prospective and double-arm study. JCEM. 2018;103(10):3877-89.

The author has declared no conflict of interest.