Hypophysitis is a rare inflammation of the pituitary gland. Various forms of hypophysitis are known, but not all physiological and immunological relationships have been clarified, especially not in the case of lymphocytic hypophysitis, which is probably due to an autoimmune reaction in the body. In the course of the hypophysitis leads to an increasing loss of pituitary function including all accompanying symptoms.

What is hypophysitis?

The most noticeable initial symptoms of hypophysitis are usually headaches and blurred vision, which can even manifest as double vision. See AbbreviationFinder for abbreviations related to Hypophysitis.

The rarely observed hypophysitis 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 hypophysitis go back to physiological processes in the endocrine gland itself. Known manifestations are granulomatous hypophysitis or lymphocytic hypophysitis.

• Secondary hypophysitis is due to diseases of the surrounding tissue structures. Granulomas, small accumulations of Langerhans giant cells and epitheloid cells as well as lymphocytes, are typical of granulomatous hypophysitis.

Langerhans giant cells and epitheloid cells arise from associations and fusions of certain macrophages that are distributed throughout the tissue, with the epitheloid cells consisting of specialized phagocytic epithelial cells. The fused cells of the granulomas are usually no longer capable of phagocytosis.

Lymphocytic hypophysitis is characterized by an immigration of lymphocytes and plasma cells and fibrous remodeling of the parenchymal tissue. An exact delineation of hypophysitis from other diseases such as benign pituitary adenoma, which affects the anterior lobe of the pituitary gland (adenohypophysis).

Causes

A lymphocytic or granulomatous hypophysitis differ not only in terms of their physiological manifestations, but the two diseases to be distinguished from each other also go back to different causes. The granulomatous inflammation of the pituitary gland largely corresponds to the classic picture of inflammation in the tissue.

The disease is usually triggered by a bacterial or viral infection, which usually occurs in the pituitary gland as a secondary infection. Isolated inflammatory pituitary infections are extremely rare. Inflammations of the sphenoid sinuses, which are part of the paranasal sinuses, are of a certain importance for a primary infection, which can spread to the pituitary gland because of its spatial proximity.

The causes that lead to lymphocytic hypophysitis, i.e. the factors that cause the increased immigration of lymphocytes, are not (yet) sufficiently understood. It is very likely that the body is having an autoimmune reaction, so that lymphocytic hypophysitis is classified as an autoimmune disease.

Symptoms, Ailments & Signs

The pituitary acts as the control and regulation center for a variety of hormones. It controls it by secreting glandotropic hormones (control hormones). Depending on the type of inflammation and depending on the focus of inflammation, which can be in one of the three parts of the pituitary gland, different glandotropic or non-glandotropic hormones are affected, which directly affect the circulation or directly control the activity of the target organ.

Hypophysitis is usually associated with reduced hormone production with the resulting symptoms and discomfort. In the case of a benign neoplasia in the form of an adenoma, hormones are usually overproduced by the autonomously secreting cells of the adenoma.

The most noticeable initial symptoms of hypophysitis are usually headaches and blurred vision, which can even manifest as double vision. Inflammation of the anterior pituitary gland (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 & course of disease

If hypophysitis is suspected due to general symptoms such as persistent headaches and visual disturbances that cannot be assigned to an organic or other cause, imaging methods such as thin-layer magnetic resonance imaging help to identify abnormalities in the pituitary gland or a thickening of the pituitary stalk in order to make the diagnosis to confirm or discard hypophysitis.

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 an examination of the cerebrospinal fluid. If certain cells are present in the cerebrospinal fluid, there is a high degree of certainty that hypophysitis is present.

Conversely, a negative finding does not rule out the possibility that the pituitary gland is inflamed. A differential diagnosis regarding pituitary adenoma is also important because the treatment of the two different diseases is also different. The course of the disease depends heavily on the causative factors, so that a mild to severe course can result, which requires appropriate therapy.

Complications

Hypophysitis causes various disorders in the patient, which occur as a result of an incorrect and unbalanced hormonal balance. These complaints have a strong negative effect not only on the physical but also on the mental state of the patient and reduce the quality of life enormously. In many cases, eye problems and headaches occur at the beginning of the disease.

The patients suffer from visual disturbances and double vision, and it is not uncommon for so-called blurred vision to occur. These complaints can lead to difficulties concentrating and coordination disorders in everyday life. In many cases, many activities are restricted by the eye problems and can no longer be carried out easily.

Treatment of hypophysitis in most cases takes place with the help of drugs 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 life expectancy of the patient is not affected by the hypophysitis. Not infrequently, hypophysitis also leads to depression or other upsets, which can also be treated medically.

When should you go to the doctor?

If symptoms such as headaches and visual disturbances are noticed that cannot be attributed to any other cause, a doctor should be consulted. Hypophysitis usually takes a slow course and causes more and more symptoms as the disease progresses. In order to avoid complications and long-term consequences, a doctor should be consulted at the first signs of illness. This applies above all to complaints that have no underlying organic cause.

Hypophysitis usually occurs in connection with a bacterial or viral infection. Autoimmune diseases are also conceivable triggers and must be ruled out as a cause if the symptoms mentioned occur. People who have advanced hypophysitis should talk to their doctor if they have any unusual symptoms. In general, treatment must be closely monitored so that any complications can be addressed quickly. The right contact person is the general practitioner, who will make the initial diagnosis and then refer the patient to a neurologist.

Treatment & Therapy

The treatment of hypophysitis aims to eliminate the foci 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 exerts on surrounding nerve nodes and nerves. The treatment therefore usually includes steroid therapy, which means that corticosteroids are initially used in relatively high doses.

If the desired results are not achieved with steroid therapy or if there is a recurrence, invasive therapies can be considered to obtain material for careful histological examination and to remove material that has already died. Irradiation of the focus of inflammation should only be considered if the standard therapies described above have failed.

Prevention

Preventive measures to prevent hypophysitis can only be indirect in nature, because direct preventive measures or medication are unthinkable. The best indirect protection consists in strengthening the immune system.

In this way, facultative germs do not get a chance and pathogenic germs are recognized and successfully eliminated by the immune system. The immune system is best strengthened through regular exercise, a diet that also contains natural foods and through phases of stress that alternate with phases of relaxation.

Aftercare

Therapy for hypophysitis is followed by a period of follow-up care to help prevent re-swelling. Follow-up treatments are therefore closely linked to prevention. However, the disease cannot be prevented directly, but only through indirect measures. These are primarily aimed at improving the immune system of those affected.

This reduces the risk of dangerous germs reappearing. At the same time, the immune system manages to detect and eliminate pathogenic germs in good time. To strengthen the immune system, patients should be physically active on a regular basis 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 long periods of stress. In the ideal case, the tension periods alternate with relaxation breaks. This not only has a positive effect on the body, but also on the psyche.

The actual therapy is about eliminating the focus of inflammation. Through the subsequent adjustments in everyday life, those affected are able to increase their defenses. For further recovery, the follow-up care should also deal with the psychological well-being.

You can do that yourself

The treatment of hypophysitis always aims to eliminate the foci of inflammation in the pituitary gland. Drug treatment usually consists of steroid therapy with corticosteroids. An adaptation of behavior in everyday life is based on the symptoms that occur, which can vary greatly because the pituitary gland, as the control center for a large number of hormones, not only has an impact on organ functions, but also has a strong influence on mental well-being.

The symptoms of an incipient hypophysitis usually manifest themselves in non-specific headaches and visual disturbances, which can manifest themselves in double vision. So-called blurred vision, which is reminiscent of cataracts but is not caused by lens opacity, is also symptomatic . Behavior in everyday life should above all take into account the possible visual disturbances, which can lead to dangerous situations when performing certain activities such as participating in road traffic as the driver of a vehicle.

Self-help measures can sensibly accompany medically prescribed drug therapy. Possible self-help measures consist above all in strengthening the immune system so that it can have a decisive influence on the containment of possible inflammatory processes in the pituitary gland and have a positive influence on the further course of the disease. The immune system can be strengthened through a varied diet, which mainly contains natural foods such as vegetables and fruit, through the use of effective relaxation techniques and through regular exercise.