[Analysis of a series of 14 clinical cases of neurosurgical treatment of hypophysitis].

Abstract

Primary hypophysitis is a rare disease that is usually diagnosed retrospectively after surgery for suspected tumors of the sellar region (pituitary adenomas, craniopharyngiomas, etc.). The most common variant of the primary forms is lymphocytic hypophysitis, characterized by the presence of lymphocytes in the inflammatory infiltrate. Granulomatous hypophysitis is the second most common variant of the disease, the cause of which remains unknown.

Objective: To study the frequency and nature of clinical manifestations, the features of MRI of the brain, as well as the results of neurosurgical treatment of patients with a confirmed histological diagnosis of hypophysitis.

Material and methods: A retrospective analysis of the case reports of 14 patients with histologically confirmed diagnosis of lymphocytic (13 cases) and granulomatous (1 case) hypophysitis operated at the Burdenko Neurosurgical Center.

Results: In none of the cases before the operation, according to the MRI data, the diagnosis of "hypophysitis" was made. Clinical symptoms were manifested by headaches in 12 patients, decreased acuity and/or visual field impairment in 9 patients, oculomotor impairments in 2 patients. Hypopituitarism was detected in 12 cases, and diabetes insipidus in 8 cases.

After surgery, 7 patients had a regression of headache and improved vision, in 5 cases there was no dynamics, in 1 case vision deteriorated. In all 8 patients with diabetes insipidus, it persisted after surgery. There were no new cases of diabetes insipidus. Panhypopituitarism was noted in all patients.

Conclusion: Given the difficulty of diagnosing hypophysitis without morphological verification, as well as the rarity of these cases, prospective multicenter studies are needed to study the pathognomonic signs of hypophysitis and improve their neuroimaging methods.