title: Lymphocytic hypophysitis: modern day management with limited role for surgery.
abstract: OBJECTIVE
  We set out to describe the modern day management of Lymphocytic hypophysitis (LH) with respect to its diagnosis, treatment and long-term endocrine and visual outcomes. We deliberately included patients with a clinical diagnosis of LH and compared them with those with a histological diagnosis following surgery.
  
  
  METHODS
  A multi-centre observational study was performed. Twenty-two patients were included and studied over a mean follow-up period of 8.6 years (range 4-26 years).
  
  
  RESULTS
  Patients presented with headache (N = 15; 68 %), visual field disturbances (N = 7; 32 %) or a combination of these symptoms (N = 5; 23 %). The time lag between onset of symptoms and diagnosis was <1 month, 1-6 months or >6 months in approximately a third of the patients each, respectively. In two-thirds of the patients (N = 14) LH was diagnosed based on their clinical, biochemical and radiological findings. The surgical cohort (N = 8) was statistically more likely to have presented with larger lesions, with suprasellar extension and greater visual field defects. During follow-up there was improvement in headaches and visual symptoms, but the rate of hypopituitarism as reflected by the need for on-going pituitary hormone replacement persisted. At the 1, 5 and 10 year follow-up there was no significant difference between the medically and surgically managed cohorts in terms of ongoing symptomatology or need for pituitary hormone replacement.
  
  
  CONCLUSIONS
  In the modern era, most patients with LH are diagnosed by non-surgical means and managed medically. There remains a significant time lag between the onset of symptoms and the eventual diagnosis of LH. Despite the considerable morbidity attached to LH, overall prognosis is good.
authors: Department of Endocrinology, Salford Royal NHS Foundation Trust (SRFT), Stott Lane, Salford, Greater Manchester, M6 8HD, UK. angelos5@doctors.org.uk.
authors: Angelos
authors: A
authors: Kyriacou
authors: Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Greater Manchester, UK.|Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors: Kanna
authors: K
authors: Gnanalingham
authors: Department of Endocrinology, Salford Royal NHS Foundation Trust (SRFT), Stott Lane, Salford, Greater Manchester, M6 8HD, UK.|Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors: Tara
authors: T
authors: Kearney
mesh_terms: D000293:Adolescent; D000328:Adult; D000069281:Autoimmune Hypophysitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D020249:Hormone Replacement Therapy; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D008297:Male; D011379:Prognosis; D055815:Young Adult
keywords: Hormone replacement; Lymphocytic hypophysitis; Presentation; Prognosis; Surgery