Clinical Characteristics Of Autoimmune Hypophysitis: A Retrospective Analysis Of 56 Cases

ObjectiveTo analyse the clinical characteristics of autoimmune hypophysitis and explore the influential factors of major clinical and imaging manifestations in order to deepen physicians' understanding of the disease and reduce misdiagnosis and missed diagnosis.MethodsThe inpatient clinical data of autoimmune hypophysitis patients first treated in Tianjin Medical University General Hospital from Jan.2008 to Aug.2018 were collected and analyzed retrospectively.We explore the influential factors of major clinical and imaging manifestations through the Binary Logistic Analysis.Results56 patients diagnosed with autoimmune hypophysitis were divided into 21 males(37.5%)and 35 females(62.5%).The age range of patients ranged from 14.0 to 72.0 years with an average age of 46.84 ±17.64 years.The duration of the disease ranged from 0.25 to 72.0 months with a median of 3.0 months.There were 2 cases of postpartum onset and no cases of pregnancy onset.The clinical manifestations of AH include pressure symptoms caused by saddle area lesions,hypopituitarism,central diabetes insipidus,hyperprolactinemia and complication with other autoimmune diseases.Headache is the most common pressure symptom of AH,with an incidence of 25.0%(14/56).The proportional order of the damaged anterior pituitary axis is as follows:pituitary-gonad axis(67.3%,37/55),pituitary-thyroid axis(40.0%,22/55),pituitary-adrenal cortex axis(24.5%,13/53)and pituitary-GH/IGF-1 axis(2.5%,1/40).Therefore,pituitary-gonad axis damage is the most common.It causes hypogonadotropic hypogonadism(HH).Central diabetes insipidus(CDI)is the most common clinical manifestation of AH,accounting for 69.6%(39/56),mainly manifested as polyuria,thirst and excessive drinking.The incidence of hyperprolactinemia was 34.5%(19/55),mainly manifested as amenorrhea and/or lactation.15 out of 56 patients were complicated with other autoimmune diseases,accounting for 26.8%.2 patients had systemic disease—Langherans' cell hystiocytosis.Pituitary stalk enlargement is the most common and characteristic imaging manifestation of AH,and the proportion is 73.2%(41/56).Glucocorticoid therapy accounted for 67.9%(38/56),which was the most common treatment for AH.33 out of 56 patients had follow-up data.The prognosis is as follows: improvement(60.6%,20/33),deterioration(21.2%,7/33),stable condition(18.2%,6/33).4 of the 20 patients who had improved relapsed in the later stage,accounting for 20%(4/20).We selected central diabetes insipidus,hyperprolactinemia,hypogonadotropic hypogonadism and pituitary stalk enlargement as research objects to explore the influential factors.Through the Binary Logistic Analysis,duration of disease is a protective factor for CDI,but pituitary stalk enlargement is a risk factor for CDI.Duration of disease is a risk factor for hyperprolactinemia.Age of consultation is a risk factor for HH,but it is a protective factor for pituitary stalk enlargement.ConclusionCentral diabetes insipidus is the most common clinical manifestation of AH.Pituitary stalk enlargement is the most common and characteristic imaging manifestation of AH.The proportional order of the damaged anterior pituitary axis is as follows:pituitary-gonad axis,pituitary-thyroid axis,pituitary-adrenal cortex axis and pituitary-GH/IGF-1 axis.The clinical diagnosis of AH can be obtained through clinical manifestations,imaging manifestations,laboratory examinations,and responses to glucocorticoid therapy.Glucocorticoid therapy is the most common treatment for AH.Through the Binary Logistic Analysis,duration of disease is a protective factor for CDI;pituitary stalk enlargement is a risk factor for CDI;duration of disease is a risk factor for hyperprolactinemia;age of consultation is a risk factor for HH;age of consultation is a protective factor for pituitary stalk enlargement.