{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:17:53Z","timestamp":1777414673207,"version":"3.51.4"},"reference-count":37,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Non-functional pituitary macroadenomas (NFPMA) are uncommon pituitary lesions that do not cause hormonal hypersecretion and are most often discovered at the macroadenoma stage. Consequently, they are more challenging to diagnose, often mimicking other non-secreting sellar masses, among which hypophysitis should be carefully considered. This study aimed to differentiate between non-functioning pituitary macroadenomas (NFPMA) and hypophysitis, two distinct sellar pathologies with overlapping MRI features, by developing a diagnostic score based on clinical, biological, and radiological criteria. Methods: We conducted a prospective study, including 56 patients with NFPMA and 16 patients with hypophysitis primarily of the lymphocytic subtype. A total of 31 clinical, biological, and radiological variables were analyzed using univariate and multivariate statistical methods to identify significant predictors and to establish a diagnostic score. Results: Nine significant criteria were identified: female sex, headaches, visual disturbances, corticotropic insufficiency, pituitary volume \u2264 7 cm3, loss of the posterior pituitary bright spot, cavernous sinus invasion, optic pathway compression, and pituitary stalk thickening. The established score demonstrated significant performance in predicting the diagnosis of hypophysitis (p &lt; 0.001; Area Under the Curve = 0.967; 95% CI = 0.926\u20131). The sensitivity and specificity of this score were 93.8% and 87.5%, respectively, using a threshold \u22650.5. The median score was \u22122 (interquartile range = [\u22123.5; 0.5]), with extremes ranging from \u22126.5 to 9. Among these, pituitary stalk thickening emerged as a key diagnostic indicator. Conclusions: This simple and effective multi-parametric score enables rapid and accurate differentiation of hypophysitis from NFPMA, helping to avoid unnecessary surgical interventions and to improve the management of pituitary insufficiencies and may be especially valuable in settings when biopsy is unavailable or risky.<\/jats:p>","DOI":"10.3390\/diagnostics15182334","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T16:27:33Z","timestamp":1757953653000},"page":"2334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Predictive Score Incorporating Clinical, Radiologic, and Hormonal Parameters to Discriminate Lymphocytic Hypophysitis from Non-Functioning Pituitary Macroadenomas"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8387-8278","authenticated-orcid":false,"given":"Ach","family":"Taieb","sequence":"first","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"},{"name":"Laboratory of Exercise Physiology and Pathophysiology, L.R. 19ES09, Sousse 4054, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ines","family":"Bouzaouache","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Radiology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayoub","family":"Gasmi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Radiology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aicha","family":"Ghachem","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imen","family":"Halloul","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiem","family":"Saafi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1581-3373","authenticated-orcid":false,"given":"ElFekih","family":"Hamza","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saad","family":"Ghada","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosra","family":"Hasni","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Houda","family":"Mhabrech","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"},{"name":"Department of Radiology, University Hospital of Farhat Hached Sousse, Sousse 4031, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.yacr.2019.05.004","article-title":"Neuroendocrine Imaging","volume":"1","author":"Burns","year":"2019","journal-title":"Adv. Clin. Radiol."},{"key":"ref_2","unstructured":"Perosevic, M., Jones, P.S., and Tritos, N.A. (2021). Magnetic resonance imaging of the hypothalamo-pituitary region. Handbook of Clinical Neurology, Elsevier. The Human Hypothalamus: Anterior Region."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.clinimag.2021.05.022","article-title":"Imaging of the sellar and parasellar regions","volume":"77","author":"Jipa","year":"2021","journal-title":"Clin. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s11102-018-0869-3","article-title":"Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas","volume":"21","author":"Ntali","year":"2018","journal-title":"Pituitary"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1210\/clinem\/dgab672","article-title":"Hypophysitis, the growing spectrum of a rare pituitary disease","volume":"107","author":"Langlois","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","first-page":"2172","article-title":"Epidemiology of pituitary adenoma: Results of the first Swiss study","volume":"5","author":"Fontana","year":"2009","journal-title":"Rev. Med. Suisse"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/j.1365-2265.2009.03667.x","article-title":"Prevalence of pituitary adenomas: A community-based, cross-sectional study in Banbury (Oxfordshire, UK)","volume":"72","author":"Fernandez","year":"2010","journal-title":"Clin. Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1210\/er.2004-0011","article-title":"Autoimmune hypophysitis","volume":"26","author":"Caturegli","year":"2005","journal-title":"Endocr. Rev."},{"key":"ref_9","first-page":"e39865","article-title":"Neurosarcoidosis-Induced Hypophysitis Mimicking Pituitary Macroadenoma","volume":"15","author":"Ach","year":"2023","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"260","DOI":"10.5603\/EP.a2019.0015","article-title":"Hypophysitis\u2014New insights into diagnosis and treatment","volume":"70","year":"2019","journal-title":"Endokrynol. Pol."},{"key":"ref_11","unstructured":"Feingold, K.R., Anawalt, B., Blackman, M.R., Boyce, A., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., Dungan, K., and Hofland, J. (2021, October 15). Hypophysitis, Endotext [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519842\/."},{"key":"ref_12","first-page":"989","article-title":"The volume of the sella turcica","volume":"87","author":"Nelson","year":"1962","journal-title":"Am. J. Roentgenol. Radium Ther. Nucl. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"998","DOI":"10.25122\/jml-2022-0196","article-title":"Comparing MRI volume measurement techniques for pituitary macroadenoma: Investigating volume reduction and its relationship with biochemical control","volume":"16","author":"Hussein","year":"2023","journal-title":"J. Med. Life"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.3174\/ajnr.A1714","article-title":"A Radiologic Score to Distinguish Autoimmune Hypophysitis from Nonsecreting Pituitary Adenoma Preoperatively","volume":"30","author":"Gutenberg","year":"2009","journal-title":"Am. J. Neuroradiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/MED.0b013e3283050844","article-title":"Pituitary stalk lesions","volume":"15","author":"Rupp","year":"2008","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/j.1552-6569.2012.00710.x","article-title":"Evaluation of MRI Criteria for Cavernous Sinus Invasion in Pituitary Macroadenoma","volume":"24","author":"Sol","year":"2014","journal-title":"J. Neuroimaging"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Knosp, E., Steiner, E., Kitz, K., and Matula, C. (1993). Pituitary adenomas with invasion of the cavernous sinus space: A magnetic resonance imaging classification compared with surgical findings. Neurosurgery, 33.","DOI":"10.1227\/00006123-199310000-00008"},{"key":"ref_18","first-page":"68","article-title":"Dural tail in pituitary adenoma","volume":"24","author":"Celli","year":"1997","journal-title":"J. Neuroradiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S0095-4543(03)00094-0","article-title":"Diagnosis and management of pituitary tumors: Recent advances","volume":"30","author":"Pickett","year":"2003","journal-title":"Prim. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"R151","DOI":"10.1530\/EJE-17-0009","article-title":"Mechanisms in Endocrinology: Hypophysitis: Diagnosis and treatment","volume":"179","author":"Joshi","year":"2018","journal-title":"Eur. J. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s11102-022-01232-0","article-title":"Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system","volume":"25","author":"Wright","year":"2022","journal-title":"Pituitary"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"104076","DOI":"10.1016\/j.lpm.2021.104076","article-title":"Hypophysitis: A comprehensive overview","volume":"50","author":"Biermasz","year":"2021","journal-title":"Presse M\u00e9d."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Taieb, A., and Mounira, E.E. (2022). Pilot Findings on SARS-CoV-2 Vaccine-Induced Pituitary Diseases: A Mini Review from Diagnosis to Pathophysiology. Vaccines, 10.","DOI":"10.3390\/vaccines10122004"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3171\/jns.2003.98.1.0183","article-title":"Apoplectic lymphocytic hypophysitis: Case report","volume":"98","author":"Lee","year":"2003","journal-title":"J. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1136\/pgmj.70.821.220","article-title":"Lymphocytic hypophysitis causing hypopituitarism and diabetes insipidus, and associated with autoimmune thyroiditis, in a non-pregnant woman","volume":"70","author":"Paja","year":"1994","journal-title":"Postgrad. Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/BF03347700","article-title":"Isolated adrenocorticotropic hormone deficiency due to probable lymphocytic hypophysitis in a man","volume":"17","author":"Varela","year":"1994","journal-title":"J. Endocrinol. Investig."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1210\/jcem-70-5-1391","article-title":"Isolated adrenocorticotropin deficiency associated with an autoantibody to a corticotroph antigen that is not adrenocorticotropin or other proopiomelanocortin-derived peptides","volume":"70","author":"Sauter","year":"1990","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1507\/endocrj.44.453","article-title":"Simultaneously found transient hypothyroidism due to Hashimoto\u2019s thyroiditis, autoimmune hepatitis and isolated ACTH deficiency after cessation of glucocorticoid administration","volume":"44","author":"Nagai","year":"1997","journal-title":"Endocr. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s11547-019-01120-x","article-title":"Imaging findings in hypophysitis: A review","volume":"125","author":"Caranci","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1007\/s11102-018-0892-4","article-title":"Neuro-radiological features can predict hypopituitarism in primary autoimmune hypophysitis","volume":"21","author":"Tartaglione","year":"2018","journal-title":"Pituitary"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1046\/j.1365-2265.2003.01784.x","article-title":"Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: Markers of tumour quiescence and regrowth","volume":"58","author":"Greenman","year":"2003","journal-title":"Clin. Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.beem.2009.05.005","article-title":"Non-functioning pituitary adenomas","volume":"23","author":"Greenman","year":"2009","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"264","DOI":"10.4158\/EP09343.CR","article-title":"Postpartum granulomatous hypophysitis with sphenoid sinus involvement: A case study","volume":"16","author":"Demetri","year":"2010","journal-title":"Endocr. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1227\/00006123-199103000-00019","article-title":"Lymphocytic hypophysitis with involvement of the cavernous sinus and hypothalamus","volume":"28","author":"Nussbaum","year":"1991","journal-title":"Neurosurgery"},{"key":"ref_35","first-page":"e58850","article-title":"Bilateral Sixth Nerve Palsy: A Rare Presentation of Primary Hypophysitis","volume":"16","year":"2024","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s701-002-8273-5","article-title":"Inflammatory Hypophysitis\u2014The Spectrum of Disease","volume":"144","author":"Flanagan","year":"2002","journal-title":"Acta Neurochir."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/cen.13058","article-title":"Pituitary stalk lesions: Systematic review and clinical guidance","volume":"85","author":"Catford","year":"2016","journal-title":"Clin. Endocrinol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2334\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:45:49Z","timestamp":1760035549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":37,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182334"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182334","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]}}}