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Lymphocytic Hypophysitis
Kalen Riley, MD, MBA; Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Lymphocytic hypophysitis (LH)
            • Synonyms

              • Adenohypophysitis, primary hypophysitis, stalkitis
            • Definitions

              • Idiopathic inflammation of pituitary gland or stalk

            IMAGING

            • General Features

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Angelousi A et al: Hypophysitis (including IgG4 and immunotherapy). Neuroendocrinology. ePub, 2020
                                    2. Caranci F et al: Imaging findings in hypophysitis: a review. Radiol Med. 125(3):319-28, 2020
                                    3. Oguz SH et al: Clinical characteristics, management, and treatment outcomes of primary hypophysitis: a monocentric cohort. Horm Metab Res. 52(4):220-7, 2020
                                    4. Pal R et al: Co-occurrence of craniopharyngioma and IgG4-related hypophysitis: an epiphenomenon or a mere coincidence? World Neurosurg. 136:193-7, 2020
                                    5. Goulam-Houssein S et al: IgG4-related intracranial disease. Neuroradiol J. 32(1):29-35, 2019
                                    6. Mekki A et al: Machine learning defined diagnostic criteria for differentiating pituitary metastasis from autoimmune hypophysitis in patients undergoing immune checkpoint blockade therapy. Eur J Cancer. 119:44-56, 2019
                                    7. Snyders T et al: Ipilimumab-induced hypophysitis, a single academic center experience. Pituitary. 22(5):488-96, 2019
                                    8. Zhu Q et al: Clinical features, magnetic resonance imaging, and treatment experience of 20 patients with lymphocytic hypophysitis in a single center. World Neurosurg. 127:e22-9, 2019
                                    9. Alessandrino F et al: Multimodality imaging of endocrine immune related adverse events: a primer for radiologists. Clin Imaging. 50:96-103, 2018
                                    10. Faje A: Immunotherapy and hypophysitis: clinical presentation, treatment, and biologic insights. Pituitary. 19(1):82-92, 2016
                                    11. Imber BS et al: Hypophysitis: a single-center case series. Pituitary. 18(5):630-41, 2015
                                    12. Tauziede-Espariat A et al: The prevalence of IgG4-positive plasma cells in hypophysitis: a possible relationship to IgG4-related disease. Clin Neuropathol. 34(4):181-92, 2015
                                    13. Chodakiewitz Y et al: Ipilimumab treatment associated pituitary hypophysitis: clinical presentation and imaging diagnosis. Clin Neurol Neurosurg. 125:125-30, 2014
                                    14. Hunn BH et al: Idiopathic granulomatous hypophysitis: a systematic review of 82 cases in the literature. Pituitary. 17(4):357-65, 2014
                                    15. Hindocha A et al: Lymphocytic hypophysitis in males. J Clin Neurosci. 20(5):743-5, 2013
                                    16. De Bellis A et al: Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism: role of antibodies to hypothalamic cells. J Clin Endocrinol Metab. 97(10):3684-90, 2012
                                    17. Peruzzotti-Jametti L et al: Bilateral intracavernous carotid artery occlusion caused by invasive lymphocytic hypophysitis. J Stroke Cerebrovasc Dis. 21(8):918, 2012
                                    18. Mirocha S et al: T regulatory cells distinguish two types of primary hypophysitis. Clin Exp Immunol. 155(3):403-11, 2009
                                    19. Molitch ME et al: Lymphocytic hypophysitis. Horm Res. 68 Suppl 5:145-50, 2007
                                    20. Zak IT et al: Imaging of neurologic disorders associated with pregnancy and the postpartum period. Radiographics. 27(1):95-108, 2007
                                    21. Unl├╝hizarci K et al: Distinct radiological and clinical appearance of lymphocytic hypophysitis. J Clin Endocrinol Metab. 86(5):1861-4, 2001
                                    22. Sato N et al: Hypophysitis: endocrinologic and dynamic MR findings. AJNR Am J Neuroradiol. 19(3):439-44, 1998
                                    23. Ahmadi J et al: Lymphocytic adenohypophysitis: contrast-enhanced MR imaging in five cases. Radiology. 195(1):30-4, 1995
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Lymphocytic hypophysitis (LH)
                                              • Synonyms

                                                • Adenohypophysitis, primary hypophysitis, stalkitis
                                              • Definitions

                                                • Idiopathic inflammation of pituitary gland or stalk

                                              IMAGING

                                              • General Features

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Angelousi A et al: Hypophysitis (including IgG4 and immunotherapy). Neuroendocrinology. ePub, 2020
                                                                      2. Caranci F et al: Imaging findings in hypophysitis: a review. Radiol Med. 125(3):319-28, 2020
                                                                      3. Oguz SH et al: Clinical characteristics, management, and treatment outcomes of primary hypophysitis: a monocentric cohort. Horm Metab Res. 52(4):220-7, 2020
                                                                      4. Pal R et al: Co-occurrence of craniopharyngioma and IgG4-related hypophysitis: an epiphenomenon or a mere coincidence? World Neurosurg. 136:193-7, 2020
                                                                      5. Goulam-Houssein S et al: IgG4-related intracranial disease. Neuroradiol J. 32(1):29-35, 2019
                                                                      6. Mekki A et al: Machine learning defined diagnostic criteria for differentiating pituitary metastasis from autoimmune hypophysitis in patients undergoing immune checkpoint blockade therapy. Eur J Cancer. 119:44-56, 2019
                                                                      7. Snyders T et al: Ipilimumab-induced hypophysitis, a single academic center experience. Pituitary. 22(5):488-96, 2019
                                                                      8. Zhu Q et al: Clinical features, magnetic resonance imaging, and treatment experience of 20 patients with lymphocytic hypophysitis in a single center. World Neurosurg. 127:e22-9, 2019
                                                                      9. Alessandrino F et al: Multimodality imaging of endocrine immune related adverse events: a primer for radiologists. Clin Imaging. 50:96-103, 2018
                                                                      10. Faje A: Immunotherapy and hypophysitis: clinical presentation, treatment, and biologic insights. Pituitary. 19(1):82-92, 2016
                                                                      11. Imber BS et al: Hypophysitis: a single-center case series. Pituitary. 18(5):630-41, 2015
                                                                      12. Tauziede-Espariat A et al: The prevalence of IgG4-positive plasma cells in hypophysitis: a possible relationship to IgG4-related disease. Clin Neuropathol. 34(4):181-92, 2015
                                                                      13. Chodakiewitz Y et al: Ipilimumab treatment associated pituitary hypophysitis: clinical presentation and imaging diagnosis. Clin Neurol Neurosurg. 125:125-30, 2014
                                                                      14. Hunn BH et al: Idiopathic granulomatous hypophysitis: a systematic review of 82 cases in the literature. Pituitary. 17(4):357-65, 2014
                                                                      15. Hindocha A et al: Lymphocytic hypophysitis in males. J Clin Neurosci. 20(5):743-5, 2013
                                                                      16. De Bellis A et al: Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism: role of antibodies to hypothalamic cells. J Clin Endocrinol Metab. 97(10):3684-90, 2012
                                                                      17. Peruzzotti-Jametti L et al: Bilateral intracavernous carotid artery occlusion caused by invasive lymphocytic hypophysitis. J Stroke Cerebrovasc Dis. 21(8):918, 2012
                                                                      18. Mirocha S et al: T regulatory cells distinguish two types of primary hypophysitis. Clin Exp Immunol. 155(3):403-11, 2009
                                                                      19. Molitch ME et al: Lymphocytic hypophysitis. Horm Res. 68 Suppl 5:145-50, 2007
                                                                      20. Zak IT et al: Imaging of neurologic disorders associated with pregnancy and the postpartum period. Radiographics. 27(1):95-108, 2007
                                                                      21. Unl├╝hizarci K et al: Distinct radiological and clinical appearance of lymphocytic hypophysitis. J Clin Endocrinol Metab. 86(5):1861-4, 2001
                                                                      22. Sato N et al: Hypophysitis: endocrinologic and dynamic MR findings. AJNR Am J Neuroradiol. 19(3):439-44, 1998
                                                                      23. Ahmadi J et al: Lymphocytic adenohypophysitis: contrast-enhanced MR imaging in five cases. Radiology. 195(1):30-4, 1995