2.3.5 Lymphocytic Hypophysitis

Suggested citation: The Endocrine Society. Endocrine Facts and Figures: Hypothalamic-Pituitary. First Edition. 2016

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Lymphocytic hypophysitis is an uncommon autoimmune disease in which the pituitary gland is infiltrated by lymphocytes, plasma cells, and macrophages that could cause posterior pituitary dysfunction (diabetes insipidus) and/or anterior pituitary dysfunction. Clinicians should suspect lymphocytic hypophysitis in pregnant women and in women with recent delivery presenting with hyperprolactinemia, headache, visual field alterations, and deficiency of one or more pituitary hormones with secondary impairment of related peripheral target glands, especially when

Lymphocytic hypophysitis is an uncommon autoimmune disease in which the pituitary gland is infiltrated by lymphocytes, plasma cells, and macrophages that could cause posterior pituitary dysfunction (diabetes insipidus) and/or anterior pituitary dysfunction. Clinicians should suspect lymphocytic hypophysitis in pregnant women and in women with recent delivery presenting with hyperprolactinemia, headache, visual field alterations, and deficiency of one or more pituitary hormones with secondary impairment of related peripheral target glands, especially when122 It can also occur less frequently in prepubertal or post-menopausal women and in men.123

2.3.5.1 Prevalence and Incidence

There has been a recent increase in the number of reported cases of lymphocytic hypophysitis (from 1962–1981,16 cases; from 1982–2001, 290 cases, and from 2002-2004, 73 cases).124 The recent increase in the use of noninvasive pituitary imaging and transsphenoidal surgery likely contributes to the increased diagnosis of lymphocytic hypophysitis, as does the growing general awareness of the condition in the medical community. A 2001 study by Buxton and Robertson reported a 1 per 9 million per year incidence estimate.124 This may well be an underestimate of today’s incidence, especially since some lymphocytic hypophysitis cases may still go undiagnosed because of their indolent, subclinical course.125

2.3.5.2 Demographic Differences

There have been reported cases of lymphocytic hypophysitis in 27 of the 193 sovereign nations of the world, but principally in Japan (34%), the US (22%), the United Kingdom (7%), Germany (7%), and Canada (5%). This might reflect a geographic or ethnic variation in risk, but it is more likely due to variations in diagnosis and/or reporting.125

One study reported that lymphocytic hypophysitis is more common in women, with a female-to-male ratio of 6:1, and that woman tend to present at a younger age (35 ± 13 years) than males (45 ± 14 years). In a significant percentage of women lymphocytic hypophysitis manifests during pregnancy or postpartum.125

2.3.5.3 Key Trends and Health Outcomes

A retrospective analysis conducted from 1997 to 2014 at a single academic center identified 21 patients (13 women and eight men) with lymphocytic hypophysitis with a median diagnosis age of 37.4 years. Patients presented with various symptoms of expanding sellar mass with most common signs including headache (57%), polyuria/polydipsia (52%), vision changes (52%), and amenorrhea or decreased libido (48%). Pre-treatment endocrine evaluation revealed that 12 (57%) patients had complete anterior hypopituitarism, 11 patients (52%) had diabetes insipidus, 10 patients (48%) had mild hyperprolactinemia and three patients (14%) had isolated endocrine axis deficiencies with partial gland function.122

Therapy is directed at treating associated anterior and posterior hormone deficiencies and/or hyperprolactinemia and controlling symptoms of headache and visual disturbance that result from mass effect. A patient might need a neurosurgical biopsy to confirm the diagnosis and exclude other neoplastic and infiltrative stalk lesions, which would require different treatments.123 Despite lack of evidence-based studies, clinicians often prescribe steroids for patients with symptomatic/problematic cases.126

Spontaneous remission can occur; so, a careful follow-up is required in all patients including pituitary function testing and sellar imaging. Symptomatic patients will need medical treatments (immunosuppressive, replacement and antiprolactinemic) and neurosurgical treatments (decompression).123

References

  1. Chung T, Monson J. Hypopituitarism [Updated 6 Feb 2015]. In: De Groot L, Beck-Peccoz P, Chrousos G, eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-
  2. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML, Endocrine S. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(6):1587-1609.
  3. Corenblum B. Hypopituitarism. 2011; http://emedicine.medscape.com/article/122287-overview – a0101. Accessed June 3 2015.
  4. Thomson Reuters, IPD Data Analytics. National Center for Health Statistics. National Hospital Discharge Survey. 2010. Accessed June 3, 2015.
  5. Regal M, Paramo C, Sierra SM, Garcia-Mayor RV. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol (Oxf). 2001;55(6):735-740.
  6. Fernandez-Rodriguez E, Lopez-Raton M, Andujar P, et al. Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients. Clin Endocrinol (Oxf). 2013;78(2):278-284.
  7. Castinetti F, Reynaud R, Saveanu A, et al. [Clinical and genetic aspects of combined pituitary hormone deficiencies]. Ann Endocrinol (Paris). 2008;69(1):7-17.
  8. Castinetti F, Reynaud R, Saveanu A, Barlier A, Brue T. Genetic causes of combined pituitary hormone deficiencies in humans. Ann Endocrinol (Paris). 2012;73(2):53-55.
  9. Kelberman D, Rizzoti K, Lovell-Badge R, Robinson IC, Dattani MT. Genetic regulation of pituitary gland development in human and mouse. Endocr Rev. 2009;30(7):790-829.
  10. Takagi M, Ishii T, Inokuchi M, et al. Gradual loss of ACTH due to a novel mutation in LHX4: comprehensive mutation screening in Japanese patients with congenital hypopituitarism. PLoS One. 2012;7(9):e46008.
  11. de Graaff LC, Argente J, Veenma DC, Drent ML, Uitterlinden AG, Hokken-Koelega AC. PROP1, HESX1, POU1F1, LHX3 and LHX4 mutation and deletion screening and GH1 P89L and IVS3+1/+2 mutation screening in a Dutch nationwide cohort of patients with combined pituitary hormone deficiency. Horm Res Paediatr. 2010;73(5):363-371.
  12. Dateki S, Fukami M, Uematsu A, et al. Mutation and gene copy number analyses of six pituitary transcription factor genes in 71 patients with combined pituitary hormone deficiency: identification of a single patient with LHX4 deletion. J Clin Endocrinol Metab. 2010;95(8):4043-4047.
  13. Reynaud R, Gueydan M, Saveanu A, et al. Genetic screening of combined pituitary hormone deficiency: experience in 195 patients. J Clin Endocrinol Metab. 2006;91(9):3329-3336.
  14. Appelman-Dijkstra NM, Kokshoorn NE, Dekkers OM, et al. Pituitary dysfunction in adult patients after cranial radiotherapy: systematic review and meta-analysis. J Clin Endocrinol Metab. 2011;96(8):2330-2340.
  15. Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013;84(8):843-849.
  16. Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA. 2007;298(12):1429-1438.
  17. Fernandez A, Brada M, Zabuliene L, Karavitaki N, Wass JA. Radiation-induced hypopituitarism. Endocr Relat Cancer. 2009;16(3):733-772.
  18. Abu Dabrh AM, Asi N, Farah WH, et al. Radiotherapy Versus Radiosurgery in Treating Patients with Acromegaly: A Systematic Review and Meta-Analysis. Endocr Pract. 2015;21(8):943-956.
  19. Bostrom JP, Meyer A, Pintea B, et al. Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas: high local control and low toxicity. Strahlenther Onkol. 2014;190(12):1095-1103.
  20. Roland Linder DKaFV. Surgery of Pituitary Tumors in Germany: Hypopituitarism, Mortality, Costs and the Effect of Surgeon. The Endocrine Society’s 94th Annual Meeting and Expo, June 23–26, 2012 – Houston, TX 2012; http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2012.NP.16.MON-718. Accessed March 15, 2016.
  21. Bates AS, Van’t Hoff W, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996;81(3):1169-1172.
  22. Bulow B, Hagmar L, Mikoczy Z, Nordstrom CH, Erfurth EM. Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf). 1997;46(1):75-81.
  23. Tomlinson JW, Holden N, Hills RK, et al. Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet. 2001;357(9254):425-431.
  24. Svensson J, Bengtsson BA, Rosen T, Oden A, Johannsson G. Malignant disease and cardiovascular morbidity in hypopituitary adults with or without growth hormone replacement therapy. J Clin Endocrinol Metab. 2004;89(7):3306-3312.
  25. van Bunderen CC, van Nieuwpoort IC, Arwert LI, et al. Does growth hormone replacement therapy reduce mortality in adults with growth hormone deficiency? Data from the Dutch National Registry of Growth Hormone Treatment in adults. J Clin Endocrinol Metab. 2011;96(10):3151-3159.
  26. Gaillard RC, Mattsson AF, Akerblad AC, et al. Overall and cause-specific mortality in GH-deficient adults on GH replacement. Eur J Endocrinol. 2012;166(6):1069-1077.
  27. Pappachan JM, Raskauskiene D, Kutty VR, Clayton RN. Excess mortality associated with hypopituitarism in adults: a meta-analysis of observational studies. J Clin Endocrinol Metab. 2015;100(4):1405-1411.
  28. Burman P, Mattsson AF, Johannsson G, et al. Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality. Journal of Clinical Endocrinology & Metabolism. 2013;98(4):1466-1475.
  29. Sherlock M, Ayuk J, Tomlinson JW, et al. Mortality in patients with pituitary disease. Endocr Rev. 2010;31(3):301-342.
  30. Nielsen EH, Lindholm J, Laurberg P. Excess mortality in women with pituitary disease: a meta-analysis. Clin Endocrinol (Oxf). 2007;67(5):693-697.
  31. Rosen T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 1990;336(8710):285-288.
  32. Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet. 2007;369(9571):1461-1470.
  33. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med. 1989;70(262):145-160.
  34. Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA. Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med. 1986;81(3):457-462.
  35. Cohen-Inbar O, Ramesh A, Xu Z, Vance ML, Schlesinger D, Sheehan JP. Gamma knife radiosurgery in patients with persistent acromegaly or Cushing’s disease: long-term risk of hypopituitarism. Clin Endocrinol (Oxf). 2016;84(4):524-531.
  36. Fatemi N, Dusick JR, Mattozo C, et al. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008;63(4):709-718; discussion 718-709.
  37. Webb SM, Rigla M, Wagner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999;84(10):3696-3700.
  38. Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR. Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab. 1994;79(2):348-354.
  39. Aimaretti G, Ambrosio MR, Benvenga S, et al. Hypopituitarism and growth hormone deficiency (GHD) after traumatic brain injury (TBI). Growth Horm IGF Res. 2004;14 Suppl A:S114-117.
  40. Stochholm K, Gravholt CH, Laursen T, et al. Mortality and GH deficiency: a nationwide study. Eur J Endocrinol. 2007;157(1):9-18.
  41. Johannsson G, Nilsson AG, Bergthorsdottir R, et al. Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation. J Clin Endocrinol Metab. 2012;97(2):473-481.
  42. Attanasio AF, Bates PC, Ho KK, et al. Human growth hormone replacement in adult hypopituitary patients: long-term effects on body composition and lipid status–3-year results from the HypoCCS Database. J Clin Endocrinol Metab. 2002;87(4):1600-1606.
  43. Di Iorgi N, Napoli F, Allegri AE, et al. Diabetes insipidus–diagnosis and management. Horm Res Paediatr. 2012;77(2):69-84.
  44. Maghnie M, Cosi G, Genovese E, et al. Central Diabetes Insipidus in Children and Young Adults. New England Journal of Medicine. 2000;343(14):998-1007.
  45. Di Iorgi N, Allegri AE, Napoli F, et al. Central diabetes insipidus in children and young adults: etiological diagnosis and long-term outcome of idiopathic cases. J Clin Endocrinol Metab. 2014;99(4):1264-1272.
  46. Schreckinger M, Szerlip N, Mittal S. Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg. 2013;115(2):121-126.
  47. Juul KV, Schroeder M, Rittig S, Norgaard JP. National Surveillance of Central Diabetes Insipidus (CDI) in Denmark: results from 5 years registration of 9309 prescriptions of desmopressin to 1285 CDI patients. J Clin Endocrinol Metab. 2014;99(6):2181-2187.
  48. Nemergut EC, Zuo Z, Jane JA, Jr., Laws ER, Jr. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005;103(3):448-454.
  49. Kristof RA, Rother M, Neuloh G, Klingmuller D. Incidence, clinical manifestations, and course of water and electrolyte metabolism disturbances following transsphenoidal pituitary adenoma surgery: a prospective observational study. J Neurosurg. 2009;111(3):555-562.
  50. Agha A, Liew A, Finucane F, et al. Conventional glucocorticoid replacement overtreats adult hypopituitary patients with partial ACTH deficiency. Clinical endocrinology. 2004;60(6):688-693.
  51. Aimaretti G, Ambrosio MR, Di Somma C, et al. Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study. J Clin Endocrinol Metab. 2005;90(11):6085-6092.
  52. Ananthakrishnan S. Diabetes insipidus in pregnancy: etiology, evaluation, and management. Endocr Pract. 2009;15(4):377-382.
  53. Aleksandrov N, Audibert F, Bedard MJ, Mahone M, Goffinet F, Kadoch IJ. Gestational diabetes insipidus: a review of an underdiagnosed condition. J Obstet Gynaecol Can. 2010;32(3):225-231.
  54. Saborio P, Tipton GA, Chan JC. Diabetes insipidus. Pediatr Rev. 2000;21(4):122-129; quiz 129.
  55. Hadjizacharia P, Beale EO, Inaba K, Chan LS, Demetriades D. Acute diabetes insipidus in severe head injury: a prospective study. J Am Coll Surg. 2008;207(4):477-484.
  56. Timper K, Fenske W, Kuhn F, et al. Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study. J Clin Endocrinol Metab. 2015;100(6):2268-2274.
  57. Vande Walle J, Stockner M, Raes A, Norgaard JP. Desmopressin 30 years in clinical use: a safety review. Curr Drug Saf. 2007;2(3):232-238.
  58. Arima H, Oiso Y, Juul KV, Norgaard JP. Efficacy and safety of desmopressin orally disintegrating tablet in patients with central diabetes insipidus: results of a multicenter open-label dose-titration study. Endocr J. 2013;60(9):1085-1094.
  59. Kennedy PG, Mitchell DM, Hoffbrand BI. Severe hyponatraemia in hospital inpatients. Br Med J. 1978;2(6147):1251-1253.
  60. Gross P, Reimann D, Neidel J, et al. The treatment of severe hyponatremia. Kidney Int Suppl. 1998;64:S6-11.
  61. Hannon MJ, Thompson CJ. The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences. Eur J Endocrinol. 2010;162 Suppl 1:S5-12.
  62. Ragnarsson O, Mattsson AF, Monson JP, et al. The relationship between glucocorticoid replacement and quality of life in 2737 hypopituitary patients. Eur J Endocrinol. 2014;171(5):571-579.
  63. Sherlock M, O’Sullivan E, Agha A, et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J. 2009;85(1002):171-175.
  64. Patterson JH. The impact of hyponatremia. Pharmacotherapy. 2011;31(5 Suppl):5S-8S.
  65. Mohan S, Gu S, Parikh A, Radhakrishnan J. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med. 2013;126(12):1127-1137 e1121.
  66. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1-42.
  67. Jahangiri A, Wagner J, Tran MT, et al. Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations. J Neurosurg. 2013;119(6):1478-1483.
  68. Callahan MA, Do HT, Caplan DW, Yoon-Flannery K. Economic impact of hyponatremia in hospitalized patients: a retrospective cohort study. Postgrad Med. 2009;121(2):186-191.
  69. Sherlock M, Reulen RC, Alonso AA, et al. ACTH deficiency, higher doses of hydrocortisone replacement, and radiotherapy are independent predictors of mortality in patients with acromegaly. J Clin Endocrinol Metab. 2009;94(11):4216-4223.
  70. Deitelzweig S, Amin A, Christian R, Friend K, Lin J, Lowe TJ. Health care utilization, costs, and readmission rates associated with hyponatremia. Hosp Pract (1995). 2013;41(1):89-95.
  71. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120(11 Suppl 1):S1-21.
  72. Levy A. Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry. 2004;75 Suppl 3:iii47-52.
  73. Agustsson TT, Baldvinsdottir T, Jonasson JG, et al. The epidemiology of pituitary adenomas in Iceland, 1955-2012: a nationwide population-based study. Eur J Endocrinol. 2015;173(5):655-664.
  74. Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010;72(3):377-382.
  75. Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006;91(12):4769-4775.
  76. Burton T, Le Nestour E, Neary M, Ludlam WH. Incidence and prevalence of acromegaly in a large US health plan database. Pituitary. 2016.
  77. Mercado M, Gonzalez B, Vargas G, et al. Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab. 2014;99(12):4438-4446.
  78. Broder MS, Neary MP, Chang E, Cherepanov D, Katznelson L. Treatments, complications, and healthcare utilization associated with acromegaly: a study in two large United States databases. Pituitary. 2014;17(4):333-341.
  79. Nachtigall L, Delgado A, Swearingen B, Lee H, Zerikly R, Klibanski A. Changing patterns in diagnosis and therapy of acromegaly over two decades. J Clin Endocrinol Metab. 2008;93(6):2035-2041.
  80. Katznelson L, Laws ER, Jr., Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-3951.
  81. Casanueva FF, Molitch ME, Schlechte JA, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf). 2006;65(2):265-273.
  82. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27(5):485-534.
  83. Klibanski A. Clinical practice. Prolactinomas. N Engl J Med. 2010;362(13):1219-1226.
  84. Schlechte JA. Clinical practice. Prolactinoma. N Engl J Med. 2003;349(21):2035-2041.
  85. Schlechte J, el-Khoury G, Kathol M, Walkner L. Forearm and vertebral bone mineral in treated and untreated hyperprolactinemic amenorrhea. J Clin Endocrinol Metab. 1987;64(5):1021-1026.
  86. Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3-6.
  87. Sheplan Olsen LJ, Robles Irizarry L, Chao ST, et al. Radiotherapy for prolactin-secreting pituitary tumors. Pituitary. 2012;15(2):135-145.
  88. Colao A, Vitale G, Cappabianca P, et al. Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinol Metab. 2004;89(4):1704-1711.
  89. Karavitaki N, Dobrescu R, Byrne JV, Grossman AB, Wass JA. Does hypopituitarism recover when macroprolactinomas are treated with cabergoline? Clin Endocrinol (Oxf). 2013;79(2):217-223.
  90. Warfield A, Finkel DM, Schatz NJ, Savino PJ, Snyder PJ. Bromocriptine treatment of prolactin-secreting pituitary adenomas may restore pituitary function. Ann Intern Med. 1984;101(6):783-785.
  91. Wang AT, Mullan RJ, Lane MA, et al. Treatment of hyperprolactinemia: a systematic review and meta-analysis. Syst Rev. 2012;1:33.
  92. Amlashi FG, Tritos NA. Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management. Endocrine. 2016.
  93. Azzalin A, Appin CL, Schniederjan MJ, et al. Comprehensive evaluation of thyrotropinomas: single-center 20-year experience. Pituitary. 2015.
  94. Jha S, Kumar S. TSH secreting pituitary adenoma. J Assoc Physicians India. 2009;57:537-539.
  95. Onnestam L, Berinder K, Burman P, et al. National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. J Clin Endocrinol Metab. 2013;98(2):626-635.
  96. Sughrue ME, Chang EF, Gabriel RA, Aghi MK, Blevins LS. Excess mortality for patients with residual disease following resection of pituitary adenomas. Pituitary. 2011;14(3):276-283.
  97. Malchiodi E, Profka E, Ferrante E, et al. Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocrinol Metab. 2014;99(6):2069-2076.
  98. Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S. Management of clinically non-functioning pituitary adenoma. Ann Endocrinol (Paris). 2015;76(3):239-247.
  99. Tjornstrand A, Gunnarsson K, Evert M, et al. The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011. Eur J Endocrinol. 2014;171(4):519-526.
  100. Olsson DS, Nilsson AG, Bryngelsson IL, Trimpou P, Johannsson G, Andersson E. Excess Mortality in Women and Young Adults With Nonfunctioning Pituitary Adenoma: A Swedish Nationwide Study. J Clin Endocrinol Metab. 2015;100(7):2651-2658.
  101. Swearingen B, Wu N, Chen SY, Pulgar S, Biller BM. Health care resource use and costs among patients with cushing disease. Endocr Pract. 2011;17(5):681-690.
  102. Ntali G, Capatina C, Fazal-Sanderson V, et al. Mortality in Patients with Non-Functioning Pituitary Adenoma is Increased: Systematic Analysis Of 546 Cases with Long Follow-Up. Eur J Endocrinol. 2015.
  103. Lindholm J, Nielsen EH, Bjerre P, et al. Hypopituitarism and mortality in pituitary adenoma. Clin Endocrinol (Oxf). 2006;65(1):51-58.
  104. Karamouzis I, Berardelli R, Prencipe N, et al. Retrospective observational analysis of non-irradiated non-functioning pituitary adenomas. J Endocrinol Invest. 2015;38(11):1191-1197.
  105. Minniti G, Scaringi C, Poggi M, et al. Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response. Eur J Endocrinol. 2015;172(4):433-441.
  106. Valassi E, Biller BM, Klibanski A, Swearingen B. Clinical features of nonpituitary sellar lesions in a large surgical series. Clin Endocrinol (Oxf). 2010;73(6):798-807.
  107. Famini P, Maya MM, Melmed S. Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients. J Clin Endocrinol Metab. 2011;96(6):1633-1641.
  108. Al-Dahmani K, Mohammad S, Imran F, et al. Sellar Masses: An Epidemiological Study. Can J Neurol Sci. 2015:1-7.
  109. Crowley RK, Hamnvik OP, O’Sullivan EP, et al. Morbidity and mortality in patients with craniopharyngioma after surgery. Clin Endocrinol (Oxf). 2010;73(4):516-521.
  110. Daubenbuchel AM, Hoffmann A, Gebhardt U, Warmuth-Metz M, Sterkenburg AS, Muller HL. Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke’s pouch: impact on long-term prognosis. Eur J Endocrinol. 2015;172(5):561-569.
  111. Kwancharoen R, Blitz AM, Tavares F, Caturegli P, Gallia GL, Salvatori R. Clinical features of sellar and suprasellar meningiomas. Pituitary. 2014;17(4):342-348.
  112. Leaes CG, Meurer RT, Coutinho LB, Ferreira NP, Pereira-Lima JF, da Costa Oliveira M. Immunohistochemical expression of aromatase and estrogen, androgen and progesterone receptors in normal and neoplastic human meningeal cells. Neuropathology. 2010;30(1):44-49.
  113. Raco A, Bristot R, Domenicucci M, Cantore G. Meningiomas of the tuberculum sellae. Our experience in 69 cases surgically treated between 1973 and 1993. J Neurosurg Sci. 1999;43(4):253-260; discussion 260-252.
  114. Ariel D, Sung H, Coghlan N, Dodd R, Gibbs IC, Katznelson L. Clinical characteristics and pituitary dysfunction in patients with metastatic cancer to the sella. Endocr Pract. 2013;19(6):914-919.
  115. Kaltsas GA, Evanson J, Chrisoulidou A, Grossman AB. The diagnosis and management of parasellar tumours of the pituitary. Endocr Relat Cancer. 2008;15(4):885-903.
  116. Turcu AF, Erickson BJ, Lin E, et al. Pituitary stalk lesions: the Mayo Clinic experience. J Clin Endocrinol Metab. 2013;98(5):1812-1818.
  117. Honegger J, Schlaffer S, Menzel C, et al. Diagnosis of Primary Hypophysitis in Germany. J Clin Endocrinol Metab. 2015;100(10):3841-3849.
  118. Ranabir S, Baruah MP. Pituitary apoplexy. Indian J Endocrinol Metab. 2011;15(Suppl3):S188-196.
  119. Moller-Goede DL, Brandle M, Landau K, Bernays RL, Schmid C. Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome. Eur J Endocrinol. 2011;164(1):37-43.
  120. Chacko AG, Chacko G, Seshadri MS, Chandy MJ. Hemorrhagic necrosis of pituitary adenomas. Neurol India. 2002;50(4):490-493.
  121. Liu ZH, Chang CN, Pai PC, et al. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci. 2010;17(6):694-699.
  122. Imber BS, Lee HS, Kunwar S, Blevins LS, Aghi MK. Hypophysitis: a single-center case series. Pituitary. 2015;18(5):630-641.
  123. Bellastella A, Bizzarro A, Coronella C, Bellastella G, Sinisi AA, De Bellis A. Lymphocytic hypophysitis: a rare or underestimated disease? Eur J Endocrinol. 2003;149(5):363-376.
  124. Buxton N, Robertson I. Lymphocytic and granulocytic hypophysitis: a single centre experience. Br J Neurosurg. 2001;15(3):242-245, discussion 245-246.
  125. Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR. Autoimmune hypophysitis. Endocr Rev. 2005;26(5):599-614.
  126. Uyama A, Sasaki M, Ikeda M, Asada M, Teramura K, Tachibana M. [A case of lymphocytic hypophysitis successfully treated with steroid pulse therapy]. No Shinkei Geka. 2007;35(11):1115-1119.

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