{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T17:32:57Z","timestamp":1779903177820,"version":"3.53.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n<jats:title>Introduction<\/jats:title>\n<jats:p>Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To identify clinical and radiological findings associated with response to glucocorticoids.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design and methods<\/jats:title>\n<jats:p>12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30\u2009\u00b1\u200927 months (range 12\u201396 months).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (<jats:italic>n<\/jats:italic>\u2009=\u20094, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (<jats:italic>n<\/jats:italic>\u2009=\u20098, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28% <jats:italic>P<\/jats:italic>\u2009=\u20090.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%; <jats:italic>P<\/jats:italic>\u2009=\u20090.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (<jats:italic>P<\/jats:italic>\u2009=\u20090.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (<jats:italic>P<\/jats:italic>\u2009=\u20090.008) but diabetes insipidus persisted in all.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-17-0123","type":"journal-article","created":{"date-parts":[[2017,6,17]],"date-time":"2017-06-17T00:35:14Z","timestamp":1497659714000},"page":"127-135","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":32,"title":["Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis"],"prefix":"10.1093","volume":"177","author":[{"given":"Isabella","family":"Lupi","sequence":"first","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirco","family":"Cosottini","sequence":"additional","affiliation":[{"name":"2Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizio","family":"Caturegli","sequence":"additional","affiliation":[{"name":"3Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Manetti","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Urbani","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Cappellani","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Scattina","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enio","family":"Martino","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Marcocci","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Bogazzi","sequence":"additional","affiliation":[{"name":"1Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref101","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2214\/ajr.159.2.1632360","article-title":"MR imaging of the pituitary stalk: size, shape, and enhancement pattern","volume":"159","year":"1992","journal-title":"American Journal of Roentgenology"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1530\/eje.1.01967","article-title":"The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index","volume":"153","year":"2005","journal-title":"European Journal of Endocrinology"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1002\/acr.20295","article-title":"American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis.","volume":"62","year":"2010","journal-title":"Arthritis Care and Research"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/j.1365-2265.2008.03180.x","article-title":"Novel autoantigens in autoimmune hypophysitis","volume":"69","year":"2008","journal-title":"Clinical Endocrinology"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1210\/jc.2012-4171","article-title":"Pituitary stalk lesions: the Mayo Clinic experience","volume":"98","year":"2013","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref281","doi-asserted-by":"crossref","first-page":"3888","DOI":"10.1210\/jc.2016-2118","article-title":"Hormonal replacement in hypopituitarism in adults: an Endocrine Society Clinical Practice Guideline","volume":"101","year":"2016","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1056\/NEJMcpc1610097","article-title":"Case records of the Massachusetts General Hospital. 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