Diagnosis of Primary Hypophysitis in Germany
Diagnosis of Primary Hypophysitis in Germany
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DOI：
10.1210/jc.2015-2152
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发表时间：
2015-10-01
影响因子：
5.8
通讯作者：
Petersenn, Stephan
中科院分区：
文献类型：
--
作者：
Honegger, Juergen;Schlaffer, Sven;Petersenn, Stephan
背景：原发性垂体炎 (PrHy) 诊断结果的代表性数据很少。 目的：本研究的目的是整理大量 PrHy 患者临床特征的一致数据。另一个目标是获得有关诊断检查中当前实践的信息。设计：德国内分泌学会垂体工作组在德国进行了一项全国性回顾性横断面队列研究。患者：确定了 76 名 PrHy 患者。主要结果指标：评估临床和内分泌特征。结果：头痛 (50%) 和体重增加 (18%) 是最常见的 非内分泌症状。只有 11% 的女性患者的垂体炎与怀孕有关。 54% 的患者就诊时发现尿崩症。低促性腺激素性性腺功能减退症是最常见的内分泌衰竭（62%），而生长激素缺乏症则是最不常见的（37%）。 86% 的患者，垂体柄增厚是普遍的神经放射学症状。与手术病例相比，未经组织学证实的病例更常出现鞍上病变，且非内分泌症状较轻。肉芽肿性垂体炎比淋巴细胞性垂体炎具有更严重的临床症状。脑脊液检查主要在参与的神经外科中心进行，而甲状腺抗体几乎全部在内分泌中心进行评估。结论：与文献相反，性腺功能减退症被发现是 PrHy 中最常见的内分泌衰竭。体重增加被确定为 PrHy 的临床症状。在大多数患者中，PrHy 可以通过特征性临床体征和症状可靠地识别，无需组织学证实。 PrHy 中的诊断方法应标准化。
Context: Representative data on diagnostic findings in primary hypophysitis (PrHy) are scarce.Objective: The objective of the study was to collate consistent data on clinical features in a large series of patients with PrHy. Another objective was to gain information on current practice in a diagnostic work-up.Design: The Pituitary Working Group of the German Society of Endocrinology conducted a nationwide retrospective cross-sectional cohort study in Germany.Patients: Seventy-six patients with PrHy were identified.Main Outcome Measures: Clinical and endocrinological features were assessed.Results: Headache (50%) and increase in body mass (18%) were the most frequent nonendocrine symptoms. Hypophysitis was associated with pregnancy in only 11% of the female patients. Diabetes insipidus was found in 54% of the patients at presentation. Hypogonadotropic hypogonadism was the most frequent endocrine failure (62%), whereas GH deficiency was the least frequent (37%). With 86%, thickening of the pituitary stalk was the prevailing neuroradiological sign. Compared with surgical cases, the cases without histological confirmation presented more often with suprasellar lesions and had less severe nonendocrine symptoms. Granulomatous hypophysitis was associated with more severe clinical symptoms than lymphocytic hypophysitis. Examination of cerebrospinal fluid was predominantly performed in participating neurosurgical centers, whereas thyroid antibodies were almost exclusively assessed in endocrinological centers.Conclusion: In contrast to the literature, hypogonadism was found to be the most frequent endocrine failure in PrHy. Weight gain was identified as a clinical sign of PrHy. In the majority of patients, PrHy can be reliably identified by characteristic clinical signs and symptoms, obviating histological confirmation. The diagnostic approach should be standardized in PrHy.