Hypophysitis is a rarely occurring inflammation of the pituitary gland. Various forms of pituitary inflammation are known, but not all physiologic and immunologic relationships have been elucidated, especially in lymphocytic pituitary inflammation, which is probably due to an autoimmune response of the body. As it progresses, pituitary inflammation leads to progressive loss of pituitary function, including all associated symptoms.
What is hypophysitis?
Hypophysitis, which is rarely seen, refers to inflammatory processes in the pituitary gland – also known as the pituitary gland. These are divided into primary and secondary forms:
- The causes of primary pituitary inflammation are due to physiological processes in the endocrine gland itself. Known manifestations are granulomatous hypophysitis or lymphocytic hypophysitis.
- Secondary hypophysitis is due to diseases of surrounding tissue structures. Typical of granulomatous hypophysitis are so-called granulomas, small accumulations of Langerhans giant cells and epithelioid cells and lymphocytes.
Langerhans giant cells and epitheloid cells arise from mergers and fusions of certain macrophages distributed in the tissue, with epitheloid cells consisting of specialized epithelial cells capable of phagocytosis. The fused cells of the granulomas are usually no longer capable of phagocytosis. Lymphocytic hypophysitis is characterized by immigration of lymphocytes and plasma cells and fibrous remodeling of the parenchymal tissue. An exact differentiation of pituitary adenitis from other diseases such as benign pituitary adenoma, which affects the anterior lobe of the pituitary gland (adenohypophysis).
Causes
Not only do lymphocytic or granulomatous pituitary inflammation differ in terms of their physiologic manifestations, but the two diseases, which can be distinguished from each other, are due to different causative agents. Granulomatous inflammation of the pituitary gland corresponds largely to the classic picture of inflammation in tissue. The disease is usually triggered by a bacterial or viral infection, which usually occurs in the pituitary gland as a secondary infection. Isolated infections of the pituitary gland that cause inflammation are extremely rare. Inflammation of the sphenoid sinuses, which are part of the paranasal sinuses, has some significance for a primary infection that can spread to the pituitary gland because of its close proximity. The causes leading to lymphocytic pituitary inflammation, i.e. the factors causing the increased immigration of lymphocytes are not (yet) sufficiently understood. In all likelihood, it is an autoimmune response of the body, so that lymphocytic hypophysitis is classified among the autoimmune diseases.
Symptoms, complaints, and signs
The pituitary gland functions as a control and regulatory center for a variety of hormones. It intervenes in a controlling manner by secreting glandotropic hormones (control hormones). Depending on the type of inflammation and depending on the focus of inflammation, which may be in one of the three parts of the pituitary gland, different glandotropic or non-glandotropic hormones are affected, directly affecting the circulation or directly controlling the activity of the target organ. Pituitary inflammation is usually associated with decreased hormone production with resulting symptoms and discomfort. In the case of benign neoplasia in the form of adenoma, overproduction of hormones by the autonomously secreting cells of the adenoma usually occurs. The most noticeable initial symptoms of pituitary inflammation are usually headaches and visual disturbances, which may even present as double vision. Inflammation of the anterior pituitary lobe (HVL) usually causes partial insufficiency of the HVL. In addition, imaging shows a thickened pituitary stalk (infundibulum), through which the gland is directly connected to the hypothalamus.
Diagnosis and disease progression
When the presence of pituitary inflammation is suspected because of general symptoms such as persistent headache and visual disturbances that cannot be attributed to an organic or other cause, imaging techniques such as thin-slice magnetic resonance imaging help to identify abnormalities in the pituitary gland or thickening of the pituitary stalk, thereby confirming or rejecting the diagnosis of pituitary inflammation.Another diagnostic tool is the examination of the lumbar fluid and the cerebrospinal fluid for certain cells. However, only a “one-sided” diagnosis can be made after examination of the CSF. If certain cells are present in the CSF, hypophysitis is almost certainly present. Conversely, a negative result does not exclude the possibility that an inflammation of the pituitary gland is present. It is also important to make a differential diagnosis regarding pituitary adenoma, because the treatment of the two different diseases is also different. The course of the disease strongly depends on the causative factors, so that a mild to severe course may result, which requires appropriate therapy.
Complications
Due to hypophysitis, the patient experiences various disorders that occur as a result of incorrect and unbalanced hormone balance. These complaints have a strong negative impact not only on the physical, but also on the psychological condition of the patient and reduce the quality of life enormously. In many cases, at the beginning of the disease there are complaints about the eyes and headaches. Patients suffer from visual disturbances and double vision, and it is not uncommon for so-called veil vision to occur. These complaints can lead to concentration difficulties and coordination problems in everyday life. In many cases, many activities are restricted by the eye complaints and can no longer be carried out without further ado. In most cases, treatment of hypophysitis takes place with the help of medication and leads to a positive course of the disease. In severe cases, irradiation of the affected area may also be necessary. Complications usually do not occur and the patient’s life expectancy is not affected by hypophysitis. It is not uncommon for hypophysitis to lead to depression or further upset, which can also be treated medically.
When should you see a doctor?
When symptoms such as headaches and visual disturbances are noticed that are not due to any other cause, a doctor should be consulted. Pituitary gland inflammation usually takes a slow course, causing increasingly severe symptoms as the disease progresses. To avoid complications and long-term consequences, a doctor should be consulted at the first signs of disease. This applies especially to complaints that are not based on an organic cause. Pituitary inflammation usually occurs in conjunction with a bacterial or viral infection. Autoimmune diseases are also conceivable triggers and must absolutely be ruled out as a cause if the symptoms mentioned occur. Individuals suffering from advanced hypophysitis should talk to their doctor if they experience any unusual symptoms. In general, treatment must be closely monitored so that rapid action can be taken in the event of any complications. The proper contact is the primary care physician, who will make the initial diagnosis and subsequently refer the patient to a neurologist.
Treatment and therapy
Treatment of pituitary inflammation aims to eliminate the focus(s) of inflammation and to reduce the possibly swollen pituitary gland back to its normal volume in order to reduce any pressure that the endocrine gland may be exerting on surrounding nerve nodes and nerves. Therefore, treatment usually involves steroid therapy, which means that corticosteroids are first used in relatively high doses. If steroid therapy does not produce the desired results or if recurrence is evident, invasive therapies may be considered to obtain material for careful histologic examination and to remove material that has already died. Irradiation of the inflammatory focus should be considered only if the standard therapies described above fail.
Prevention
Preventive measures to prevent pituitary inflammation can only be indirect because direct preventive measures or medications are not conceivable. The best indirect protection is to strengthen the immune system. In this way, facultative pathogenic germs do not get a chance and pathogenic germs from the immune system are also recognized and successfully eliminated. The immune system is strengthened in the best possible way by regular exercise, a diet that also includes naturally left foods and by stress phases alternating with phases of relaxation.
Aftercare
Treatment of hypophysitis is followed by a period of aftercare, which helps prevent recurrence of swelling. Thus, follow-up treatments are closely related to prevention. However, the disease cannot be prevented directly, but only by indirect measures. These are aimed primarily at improving the immune system of those affected. This reduces the risk of the dangerous germs reappearing. At the same time, the immune system succeeds in detecting and eliminating the pathogenic germs in time. To strengthen the immune system, patients should be regularly active in sports and eat a healthy, balanced diet. The focus of the diet is on natural foods. For a health-conscious lifestyle, it is important that patients are not exposed to prolonged periods of stress. Optimally, periods of stress alternate with periods of relaxation. This has a positive effect not only on the body, but also on the psyche. The actual therapy is about eliminating the focus of inflammation. Subsequent adjustments in everyday life enable those affected to increase their defenses. For further recovery, follow-up care should also address psychological well-being.
Here’s what you can do yourself
Treatment of pituitary inflammation is always aimed at eliminating the focus(s) of inflammation in the pituitary gland. Most often, drug treatment consists of steroid therapy with corticosteroids. An adjustment of behavior in everyday life is based on the symptoms that occur, which can be very different, because the pituitary gland as the control center of a large number of hormones not only affects organ functions, but also exerts a strong influence on the psychological well-being. The symptoms of incipient pituitary gland inflammation usually manifest themselves in nonspecific headaches and in visual disturbances, which can manifest themselves in double images. Also symptomatic is so-called veil vision, which is reminiscent of cataracts but is not caused by lens opacity. Behavior in everyday life should take into account the possible visual disturbances, which can lead to dangerous situations when performing certain activities such as participating in road traffic as a driver of a vehicle. Self-help measures can usefully accompany a medically prescribed drug therapy. Possible self-help measures consist primarily of strengthening the immune system so that it can have a decisive influence on containing the possible inflammatory processes in the pituitary gland and positively influence the further course of the disease. The immune system can be strengthened by a varied diet containing mainly natural foods such as vegetables and fruits, by using effective relaxation techniques, and by regular exercise.
