Case series and review of the literature on the surgical management of hypophysitis: the endocrine outcome seems to be worsened by surgery

Miquel Lea; Testud Benoit; Nicolas Sahakian; Cecilia Piazzola; Frederique Albarel; Thomas Cuny; Thierry Brue; Henri Dufour; Frederic Castinetti; Thomas Graillon

doi:10.1530/endoabs.110.P965

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Endocrine Abstracts (2025) 110 P965 | DOI: 10.1530/endoabs.110.P965

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Case series and review of the literature on the surgical management of hypophysitis: the endocrine outcome seems to be worsened by surgery

Miquel Léa ¹ , Testud Benoit ² , Nicolas Sahakian ³ , Cecilia Piazzola ³ , Frederique Albarel ³ , Thomas Cuny ³ , Thierry Brue ³ , Henri Dufour ⁴ , Frederic Castinetti ³ & Thomas Graillon ⁴

Author affiliations

¹Service de médecine interne et immunologie clinique, Hôpital de La Conception, Assistance Publique Hôpitaux de Marseille (AP-HM), 13, Marseille, France; ²Aix Marseille Université, Service de radiologie, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille (AP-HM), 13, Marseille, France; ³Aix Marseille Université, MMG, INSERM U125, Marmara Institute, Assistance Publique Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, CRMR HYPO, 13, Marseille, France; ⁴Aix Marseille Université, Service de neurochirurgie, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13, Marseille, France

JOINT3410

Aims: Hypophysitis is an inflammation of the pituitary gland or stalk, lacking standardized diagnostic and treatment guidelines. This study aims to explore the role of surgery in the diagnosis and treatment of hypophysitis.

Patient and Methods: We conducted a monocentric retrospective observational study in a university tertiary hospital. Patients over 15 years of age diagnosed with hypophysitis thanks to histological documentation between January, 1^st, 1994 and October, 31^st, 2023 were included. A literature review was also performed on cases involving surgical and medical management, collecting data on characteristics, endocrine function, surgery, and complications.

Results: Nine patients were included in our cohort, with surgery primarily performed due to visual disturbances (75%). Almost half were initially suspected of having an pituitary adenoma. All patients recovered their visual function after surgery. The literature review regarding surgical management covered 289 operated patients from 21 articles, among which 204 had partial or complete surgical resection. Endocrine impairment was observed in 66.5% patients. Forty percent underwent surgery due to a misdiagnosis of adenoma, and 40% for visual impairment. After surgery, 20% developed new endocrine deficiency, while 13% showed hormonal improvement. Surgery resulted in visual improvement in about 80% cases. Non-endocrine complications remains rare but could be severe (5%). Neuropathology was contributive in 98.3% cases. The literature review of all management covered 661 patients. Glucocorticoids prevent the occurrence of new deficiency (2.1%) compared with surgery (25%) or observation alone (14%) (P < 0.001). Glucocorticoids improve endocrine function and leading to the recovery of at least one deficiency in 32% cases, better than surgery (13.2%) or observation alone (19%) (P = 0.002).

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	Observation n = 263	Glucocorticoids n = 137	Resection n = 219	p
New deficiency	0/159	0%	0/94	0%	16/108	14.8%	<0.0001^BC
AVP-D Corticotroph deficiency	10/100	10%	0/94	0%	14/141	9.9%	0.0065^AB
Thyrotroph deficiency	4/100	4%	0/94	0%	12/108	11.1%	0.0016^B
Panhypopiutarism	0/100	0%	0/94	0%	9/86	10.4%	<0.0001^BC
&unixF0B3; 1 deficiency	21/151	13.9%	2/94	2.1%	52/211	24.6%	<0.0001^ABC
Recovery of deficiency	9/152	5.9%	17/90	18.9%	10/152	6.6%	0.0012^AB
Gonadotroph deficiency ≥ 1 deficiency	38/204	18.6%	37/116	31.9%	29/219	13.2%	0.0002^AB
^AP < 0.05 between observation and glucocorticoids ^BP < 0.05 between glucocorticoids and resection ^CP < 0.05 between observation and resection.

Conclusion: Surgical management in hypophysitis has clear diagnostic value and is part of the therapeutic armamentarium. It should be discussed as a first-line treatment for visual impairment. The risk of worsening endocrine function should be balance with the value of surgery when indicated.