Hypophysitis: Difference between revisions

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Revision as of 01:11, 6 June 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords:Autoimmune hypophysitis, lymphocytic hypophysitis

Overview

Hypophysitis is the inflammation of the pituitary gland that typically results in some degree of pituitary dysfunction, ranging from under secretion of some pituitary hormones to complete panhypopituitarism requiring lifelong hormone supplementation. While hypophysitis by itself is seldom life-threatening, the sequelae of pituitary inflammation, particularly adrenal insufficiency and severe hypothyroidism, may be fatal if unrecognized and left untreated. There are several recognized causes of hypophysitis, including lymphocytic infiltration, granulomatous infiltration (e.g. in the setting of a systemic granulomatous disease such as sarcoidosis or granulomatosis with polyangiitis), and cell-mediated autoimmune reactivity in the setting of treatment of certain solid tumors with immunomodulatory checkpoint inhibitors (i.e. CTLA-4 inhibitors and PD-1 inhibitors). Although there are several different subtypes of hypophysitis, there are many commonalities in the diagnostic evaluation and treatment of this rare endocrinopathy.

Historical Perspective

Classification

Pathophysiology

Genetics

Associated Conditions

Gross Pathology

Microscopic Pathology

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

A...
Z...

Make sure that each diagnosis is linked to a page.

Differentiating type page name here from other Diseases

Epidemiology and Demographics

Age

Gender

Race

Developed Countries

Developing Countries

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

If available, the diagnostic criteria are provided here.

History

A directed history should be obtained to ascertain

Symptoms

"Type symptom here" is pathognomonic of the "type disease name here".

"Type non specific symptoms" may be present.

Past Medical History

Family History

Social History

Occupational

Alcohol

The frequency and amount of alcohol consumption should be characterized.

Drug Use

Smoking

Allergies

Physical Examination

Appearance of the Patient

Vital Signs

Skin

Head

Eyes

Ear

Nose

Mouth

Throat

Heart

Lungs

Abdomen

Extremities

Neurologic

Genitals

Other

Laboratory Findings

Electrolyte and Biomarker Studies

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Surgery and Device Based Therapy

Indications for Surgery

Pre-Operative Assessment

Post-Operative Management

Transplantation

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

References

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WikiDoc Sources

v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)

@@ Line 20: / Line 20: @@
 ==Overview==
-'''Hypophysitis''' is the inflammation of the [[pituitary gland]] that typically results in some degree of pituitary dysfunction, ranging from under secretion of some pituitary hormones to complete panhypopituitarism requiring lifelong hormone supplementation. While hypophysitis by itself is seldom life-threatening, the sequelae of pituitary inflammation, particularly adrenal insufficiency and severe hypothyroidism, may be fatal if unrecognized and left untreated. There are several recognized causes of hypophysitis, including lymphocytic infiltration, granulomatous infiltration (e.g. in the setting of a systemic granulomatous disease such as sarcoidosis or granulomatosis with polyangiitis), and cell-mediated autoimmune reactivity in the setting of treatment of certain solid tumors with immunomodulatory checkpoint inhibitors (i.e. CTLA-4 inhibitors and PD-1 inhibitors). Although there are several different subtypes of hypophysitis, there are many commonalities in the diagnostic evaluation and treatment of this rare endocrinopathy.
+'''Hypophysitis''' is the inflammation of the [[pituitary gland]] that typically results in some degree of pituitary dysfunction, ranging from under secretion of some pituitary hormones to complete [[panhypopituitarism]] requiring lifelong hormone supplementation. While hypophysitis by itself is seldom life-threatening, the sequelae of pituitary inflammation, particularly [[adrenal insufficiency]] and [[severe hypothyroidism]], may be fatal if unrecognized and left untreated. There are several recognized causes of hypophysitis, including lymphocytic infiltration, granulomatous infiltration (e.g. in the setting of a systemic granulomatous disease such as [[sarcoidosis]] or [[granulomatosis with polyangiitis]]), and cell-mediated autoimmune reactivity in the setting of treatment of certain solid tumors with immunomodulatory [[checkpoint inhibitors]] (i.e. [[CTLA-4 inhibitors]] and [[PD-1 inhibitors]]). Although there are several different subtypes of hypophysitis, there are many commonalities in the diagnostic evaluation and treatment of this rare endocrinopathy.
+==Historical Perspective==
+==Classification==
+== Pathophysiology==
+=== Genetics ===
+=== Associated Conditions===
+===Gross Pathology===
+===Microscopic Pathology===
+==Causes==
+===Life Threatening Causes===
+Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
+===Common Causes===
+===Causes by Organ System===
+{|style="width:80%; height:100px" border="1"
+|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Chemical / poisoning'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Dermatologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Drug Side Effect'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Ear Nose Throat'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Endocrine'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Environmental'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Gastroenterologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Genetic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Hematologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Iatrogenic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Infectious Disease'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Musculoskeletal / Ortho'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Neurologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Nutritional / Metabolic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Obstetric/Gynecologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Oncologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Opthalmologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Overdose / Toxicity'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Psychiatric'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Pulmonary'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Renal / Electrolyte'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Rheum / Immune / Allergy'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Sexual'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Trauma'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Urologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Dental'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Miscellaneous'''
+|bgcolor="Beige"| No underlying causes
+|-
+|}
+===Causes in Alphabetical Order===
+*A...
+*Z...
+Make sure that each diagnosis is linked to a page.
+==Differentiating type page name here from other Diseases==
+== Epidemiology and Demographics ==
+===Age===
+===Gender===
+===Race===
+===Developed Countries===
+===Developing Countries===
+== Risk Factors ==
+== Screening ==
+== Natural History, Complications and Prognosis==
+== Diagnosis ==
+===Diagnostic Criteria===
+If available, the diagnostic criteria are provided here.
+===History===
+A directed history should be obtained to ascertain
+=== Symptoms ===
+"Type symptom here" is pathognomonic of the "type disease name here".
+"Type non specific symptoms" may be present.
+===Past Medical History===
+===Family History===
+===Social History===
+====Occupational====
+====Alcohol====
+The frequency and amount of alcohol consumption should be characterized.
+====Drug Use====
+====Smoking====
+===Allergies===
+=== Physical Examination ===
+==== Appearance of the Patient ====
+====Vital Signs====
+====Skin====
+====Head====
+==== Eyes ====
+==== Ear ====
+====Nose====
+====Mouth====
+====Throat ====
+==== Heart ====
+==== Lungs ====
+==== Abdomen ====
+==== Extremities ====
+==== Neurologic ====
+====Genitals====
+==== Other ====
+=== Laboratory Findings ===
+==== Electrolyte and Biomarker Studies ====
+==== Electrocardiogram ====
+==== Chest X Ray ====
+====CT ====
+==== MRI ====
+==== Echocardiography or Ultrasound ====
+==== Other Imaging Findings ====
+=== Other Diagnostic Studies ===
+== Treatment ==
+=== Pharmacotherapy ===
+==== Acute Pharmacotherapies ====
+==== Chronic Pharmacotherapies ====
+=== Surgery and Device Based Therapy ===
+==== Indications for Surgery ====
+==== Pre-Operative Assessment ====
+==== Post-Operative Management ====
+==== Transplantation ====
+=== Primary Prevention ===
+=== Secondary Prevention ===
+=== Cost-Effectiveness of Therapy ===
+=== Future or Investigational Therapies ===
+==References==
+{{Reflist|2}}
+[[Category:Disease]]
 {{Symptoms and signs}}