title: VARIATIONS IN CLINICAL AND IMAGING FINDINGS BY TIME OF DIAGNOSIS IN FEMALES WITH HYPOPITUITARISM ATTRIBUTED TO LYMPHOCYTIC HYPOPHYSITIS.
abstract: OBJECTIVE
  To describe the various patterns of presentation, including assisting analyses, associated with the timing of diagnosis of females with hypopituitarism and suspected clinical diagnosis of lymphocytic hypophysitis.
  
  
  METHODS
  A retrospective study of 9 consecutive females with pituitary dysfunction developed during or after pregnancy. All subjects were treated in our clinics between 2008 and 2014. Data were collected on clinical characteristics, pituitary hormone levels, and imaging findings.
  
  
  RESULTS
  The study group included 9 patients with a mean age 33.7 ± 7.8 years at delivery. The probable cause of disease was lymphocytic hypophysitis. Headache or specific symptoms/signs of hypopituitarism appeared within 1 year of delivery. Five patients had headache, and 8 had difficulty breastfeeding or amenorrhea. Laboratory findings included central hypocortisolism (8/9 patients), hypogonadotropic hypogonadism (8/9), and central hypothyroidism (6/7). Insulin-like growth factor-1 (IGF-1) levels were low in 8/8 patients. Prolactin levels were low in 3/9 patients, and 1 patient had diabetes insipidus. Seven patients were diagnosed less than 1 year from symptom onset; 4 (57%) complained of headaches, and 5 (71%) had panhypopituitarism. Two patients were diagnosed later. Both had difficulty breastfeeding and amenorrhea, and one also had headaches. Both had panhypopituitarism and reduced pituitary volume. None of the patients fully recovered pituitary function. Normalization of the thyrotroph axis occurred in 3 patients, gonadotroph function in 3, the corticotroph axis in 2, and IGF-1 normalized in 1 subject.
  
  
  CONCLUSIONS
  Hypopituitarism attributed to lymphocytic hypophysitis may present during pregnancy or early postpartum period with a clear clinical picture, or later, with indolent and nonspecific symptoms and signs.
authors.forename: Amit
authors.initials: A
authors.lastname: Tirosh
authors.forename: Dania
authors.initials: D
authors.lastname: Hirsch
authors.forename: Eyal
authors.initials: E
authors.lastname: Robenshtok
authors.forename: Hiba
authors.initials: H
authors.lastname: Masri-Iraqi
authors.forename: Uri
authors.initials: U
authors.lastname: Yoel
authors.forename: Yoel
authors.initials: Y
authors.lastname: Toledano
authors.forename: Orit
authors.initials: O
authors.lastname: Twito
authors.forename: Gloria
authors.initials: G
authors.lastname: Tsvetov
authors.forename: Ilan
authors.initials: I
authors.lastname: Shimon
mesh_terms: D000328:Adult; D000069281:Autoimmune Hypophysitis / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015588:Observer Variation; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult