| Objective:This study aims to analyze the characteristics,clinical manifestations,diagnostic points,treatment and the prognosis of Autoimmune hypophysitis(AH).This study also aims to explore the influencing factors of impaired pituitary function.Moreover,the effects of AH treatment on body mass index and glucose and lipid metabolism levels were analyzed.By increasing the understanding of AH,this study provides reference for the diagnosis and treatment of AH in clinical management.Methods:1.A total of 29 patients who were diagnosed with AH in the First Bethune Hospital of Jilin University and China-Japan Union Hospital of Jilin University from February2000 to February 2023 were selected.And general patient data,such as clinical manifestations,auxiliary examination,treatment and outcome were collected.2.Fisher’s exact test was used to compare the effects of different treatments on the outcome of patients.3.The influencing factors of impaired pituitary function were analyzed by binary Logistic regression.4.Paired sample t test was used to find the changes of body mass index,fasting blood glucose and blood lipid levels in AH patients before and after treatments.5.Paired sample rank sum test was used to calculate the changes of body mass index and fasting blood glucose level,blood lipid level before and after surgery,surgery combined with hormone replacement therapy and hormone therapy and calculated the changes of blood lipid level before and after surgery combined with hormone replacement therapy and hormone therapy.Results:1.Among the 29 AH patients,the results showed that 18(62.1%)of them were female and 11(37.9%)of them were male,with a ratio of male to female 1:1.6.Patients’ age were ranged from 14 to 73 years old,with the average age of 50.5±14.3.The duration of patients’ disease was from 0.3 to 96.0 months,and the median duration of their disease was 13(2.5,20.5)months.Three patients(10.3%)were diagnosed with other autoimmune diseases at the same time,and all of them were female.Among these29 patients,11(37.9%)of them were overweight and 3(10.3%)of them were obese.Lymphocytic hypophysitis was the most common pathological type in 11 patients(73.3%)who underwent surgical and pathological biopsy.2.Twenty-two patients(75.9%)exhibit different degrees of sellar region compression symptoms,of which 19 patients(86.4%)had headache,which was the most common symptom of sellar region compression.Among the 25 patients(86.2%)who had endocrine symptoms,15(60.0%)of their symptoms were accompanied by polydipsia and polyuria,which were the most common endocrinal symptoms.3.Laboratory examination of anterior pituitary and target glands showed that the proportion of hypofunction from high to low was secondary hypogonadism,secondary adrenocortical hypofunction,secondary hypothyroidism,and growth hormone deficiency.Pituitary-gonadal axis was the most frequently affected(55.6%),and pituitary-GH /IGF-1 axis was the least affected(3.7%).The results of glucose and lipid metabolism showed that 7 of the 29 patients(24.1%)had high fasting blood glucose,and there was no patient who had fasting blood glucose below the normal reference range.Blood lipid examination showed that 12 of the 16 patients(75.0%)were diagnosed with dyslipidemia.In these condition,hypertriglyceridemia and hyperlowdensity lipoproteinemia were the common(8 cases,66.6% each).The incidence of low high-density lipoprotein cholesterol was the lowest(3 cases,25.0%).4.Visual field examination showed that 9 of 19 patients(47.4%)had visual field scotoma or visual field defect,which was the most common manifestation of visual field impairment.Pituitary imaging examination showed that 21 of 29 patients(72.4%)had intrasellar enlargement,which was the most common imaging manifestation of AH.5.Binary Logistic regression analysis showed that the age of patients at diagnosis was a risk factor for secondary adrenal insufficiency(P<0.05).6.Analysis of patients’ outcomes showed that 26(89.7%)of 29 patients improved after four different treatments,but 3(10.3%)of them did not improve,and 6(23.1%)of the improved patients relapsed.Among them,6 patients treated only by surgery were improved(100%),and 1 patient(16.7%)relapsed.Eight patients with surgery combined with hormone therapy were improved(100.0%),and no recurrence(0.0%);Of the 13 patients treated with glucocorticoid alone,11(84.6%)of them improved,but 2(15.4%)of them did not improve,and 5(45%)of the 11 patients who improved relapsed.Within the 2 patients who were only followed up,1(50%)of them was improved,1(50%)of them was not improved,and 1(0.0%)of them was improved without recurrence.7.There was no statistically significant difference in the effect of the four treatment methods on the outcome of patients.8.The effect of AH treatment on body mass index and glucose and lipid metabolism of patients showed that surgical treatment and hormone therapy increased the values of BMI and LDL-C,but no effect on the values of fasting blood glucose,HDL-C,TG or TC.9.Hormone therapy increased the value of BMI and fasting blood glucose and LDL-C.Conclusion:1.The incidence of AH is higher in women than in men,and female patients are more likely to be complicated with other autoimmune diseases.Lymphocytic hypophysitis is the most common pathological type of primary hypophysitis.2.Headache was the most common symptom of sellar region compression,and polydipsia and polyuria were the most common endocrine symptoms.3.The analysis of pituitary dysfunction showed that the pituitary-gonadal axis was the most susceptible to be affected,and the pituitary-GH /IGF-1 axis was the least affected.Intrasellar enlargement is the most common imaging manifestation of AH.4.Age at diagnosis is a risk factor for secondary adrenal insufficiency.5.The improvement rate of surgery alone and surgery combined with hormone therapy were the highest,and the recurrence rate of hormone therapy alone was the highest.There was no significant difference in the effect of the different treatment methods on the outcome of AH patients.6.The BMI and LDL-C values of AH patients increased after treatment.Hormone therapy significantly increased the BMI,fasting blood glucose and LDL-C values of patients. |
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