Publication:

Autoimmune hypophysitis: a study of natural course

Background Autoimmune hypophysitis is a rare autoimmune endocrinopathy. Literature on natural history of autoimmune hypophysitis is scarce.

Methods We prospectively studied patients with autoimmune hypophysitis between January 2013 to June 2015 and all subjects were followed for at least 6 months. Autoimmune hypophysitis was diagnosed based on clinicoradiologic findings. All patients diagnosed with autoimmune hypophysitis were followed every three monthly with evaluation for pituitary functions and six monthly with gadolinium enhanced MRI of pituitary. Deficient hormones were replaced and none of the patients were treated with immunosuppressive therapy or surgery.

Results Ten cases of autoimmune hypophysitis were diagnosed during the study period. Adrenocorticotropin deficiency was the most common (7/10) followed by thyroid stimulating hormone and gonadotropins (each in 5). Pituitary enlargement and stalk thickening were the most common imaging findings. Three patients had recovery of one hormone in each and none of the patients had progression of mass or new hormone deficiency on follow-up.

Conclusions The study describes natural history of autoimmune hypophysitis in 10 patients from a single center. We suggest against the routine use of immunosuppressive therapy or surgery in patients with autoimmune hypophysitis.