title: Corticosteroid treatment buys time in case of a newly diagnosed hypophysitis with visual deterioration.
abstract: Hypophysitis is an important differential diagnosis for a pituitary mass, especially in young women at the end of or shortly after pregnancy. It commonly results in hypopituitarism and can be differentiated from adenoma on MRI. Typical MRI characteristics of hypophysitis are symmetry, loss of posterior bright spot, intense and homogeneous gadolinium enhancement, a thickened pituitary stalk and intact sellar floor. Treatment of choice in the acute phase of a hypophysitis is corticosteroids. Adequate corticosteroid treatment may effectively buy time and avoid unnecessary surgical treatment and is related to further decrease of pituitary function, even in progressive cases of deterioration due to compression of the chiasm. Strict monitoring of the vision and a control MRI is obligatory to evaluate the treatment after 48-36 h. Tissue diagnosis is mandatory when there are multiple relapses. We present a case of progressive visual deterioration in hypophysitis, successfully treated with high-pulse dose prednisolone.
authors.affiliation: Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Marike
authors.initials: M
authors.lastname: Broekman
authors.forename: Stephan Hendrik
authors.initials: SH
authors.lastname: Goedee
authors.forename: Willy-Anne
authors.initials: WA
authors.lastname: Nieuwlaat
authors.forename: Paul
authors.initials: P
authors.lastname: Depauw
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D008775:Methylprednisolone / Q000008:administration & dosage*; D010900:Pituitary Diseases / Q000150:complications / Q000188:drug therapy*; D010903:Pituitary Gland, Anterior; D011644:Puerperal Disorders / Q000188:drug therapy*; D014786:Vision Disorders / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone
references.citation: Pituitary. 2006;9(1):35-45
references.pmid: 16703407
references.citation: Autoimmun Rev. 2010 Jan;9(3):153-7
references.pmid: 19539059
references.citation: Clin Neuropathol. 2010 Jan-Feb;29(1):26-31
references.pmid: 20040330
references.citation: AJNR Am J Neuroradiol. 2009 Oct;30(9):1766-72
references.pmid: 19628625
references.citation: Horm Res. 2007;68 Suppl 5:145-50
references.pmid: 18174733
references.citation: Curr Opin Endocrinol Diabetes Obes. 2012 Aug;19(4):314-21
references.pmid: 22543347
references.citation: Eur J Endocrinol. 2003 Nov;149(5):363-76
references.pmid: 14585081
references.citation: ScientificWorldJournal. 2010 Jan 21;10:126-34
references.pmid: 20098956
references.citation: Pituitary. 2006;9(4):331-3
references.pmid: 17080263
references.citation: J Clin Neurosci. 2003 Jul;10(4):409-13
references.pmid: 12852876