Clinical presentation and magnetic resonance imaging characteristics of lymphocytic hypophysitis: a systematic review with meta-analysis

Abstract

Introduction This meta-analysis was performed to analyze the clinical presentation, magnetic resonance imaging (MRI) characteristics, and the management of lymphocytic hypophysitis (LYH). Material and Methods Two researchers searched the Cochrane Controlled Trials Register (CCTR), Ovid, PubMed, Excerpta Medica Database (EMBASE), and the Chinese Biomedical Literature Databases (CBM). The databases were searched from January 2010 to December 2020. References and related reviews found in the literature were also retrieved. Results The meta-analysis showed that the percentage of women in LYH patients was 78%. Lymphocytic hypophysitis was associated with pregnancy in 15% of the female patients, with headache (49%) and symptoms of central diabetes insipidus (CDI) (45%) being the most frequent presentation. In 24% of the LYH patients, there was an association with another autoimmune disease. The incidence of secondary hypogonadism, secondary hypoadrenalism, secondary hypothyroidism, and growth hormone deficit was 54%, 49%, 43%, and 22%, respectively. Pituitary contrast enhancement (63%), symmetrical pituitary enlargement (60%), thickening of the pituitary stalk (58%), sella mass or suprasellar extension (58%), and loss of posterior pituitary hyperintensity (50%) were typical MRI findings. Regarding LYH treatment, the percentage of patients who had observation or hormone replacement, steroid therapy, and surgery was 43%, 36%, and 34%, respectively. Conclusions It is of great significance to fully understand the clinical characteristics of lymphocytic hypophysitis, reduce missed diagnosis and misdiagnosis, avoid unnecessary surgery and maintain normal pituitary function.

Keywords

• lymphocytic hypophysitis
• clinical characteristics
• magnetic resonance imaging
• management
• pituitary function