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.


  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.