Treatment of Hypophysitis with Rapid Onset of Neurological Symptoms and Pituitary Mass Effects
When hypophysitis manifests acutely with rapid-onset neurological symptoms caused by pituitary enlargement, the resulting mass effect on surrounding structures creates an urgent clinical situation requiring prompt, structured management.
This protocol addresses patients with rapid onset of neurological symptoms and mass effects due to pituitary enlargement — a presentation in which immunosuppressive therapy is a central component of care.
Treatment approach (partial)
Management involves immunosuppressive therapy; in select patients, specific additional immunosuppressive agents may be considered based on disease subtype and prior treatment response. The full regimen, selection criteria, and clinical decision points are detailed in the structured protocol.
References
- Immunosuppressive therapy is utilized for patients with rapid onset of neurological symptoms and mass effects due to pituitary enlargement.
- Other immunosuppressive agents such as azathioprine, methotrexate, and cyclosporine A can be used in patients who relapse or do not respond to glucocorticoid therapy, and these modalities have been shown to be effective in both PHy and SHy.
- Rituximab can be of potential benefit, especially among those patients with IgG4Hy or those with a biopsy-proven B-lymphocyte predominant, steroid-refractory hypophysitis.
DOI: 10.1016/j.beem.2019.101371
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