What is Lymphocytic Hypophysitis?

  • Lymphocytic Hypophysitis was first described by Dr Goudie and Dr Pinkerton in 1962.

  • In pregnancy, the pituitary gland is already enlarged to provide the hormones needed to grow your baby.

  • Lymphocytic Hypophysitis is an autoimmune condition, where the body’s immune system mistakes the cells of the pituitary gland for a pathogen or “invader”.

  • Immune system cells such as lymphocytes are sent to the pituitary, where they cause damage by attacking the cells.

  • This causes the pituitary gland to become inflamed and significantly enlarged.

    [1] [2]

Terminology explained

  • Lymphocytic - means related to immune system cells

  • Hypophysis - anatomical name for the pituitary gland

  • itis - means inflammation

  • Lymphocytic Hypophysitis - “Inflammation of the hypophysis by immune system lymphocytes”.

Pituitary Gland Explained

Incidence & Prevalence

  • Lymphocytic Hypophysitis can affect both women and men, however women are more likely to experience it with an 8 : 1 ratio.

  • This incidence increases for women in the last six months of pregnancy and the first six months after giving birth.

  • The average age of diagnosis for a woman is 34 years.

  • We need more data on the prevalence of Lymphocytic Hypophysitis in pregnancy and post-partum around the world.

Acute Presentation and Treatment

  • Inflammation and enlargement of your pituitary can cause intense headaches and visual disturbance if your optic chiasm (nerve to your eyes) is compressed.

  • Doctors may treat this with steroid therapy to reduce the inflammation.

  • If your vision is still affected, transsphenoidal surgery may be required to reduce the compression of your optic nerve.

  • The term “transsphenoidal” refers to the route the surgeon takes to access your pituitary gland. It is a less invasive way to access your pituitary via your nostril and sinuses.

    [3]

Diagnosis

  • Lymphocytic Hypophysitis can be diagnosed through a biopsy (carried out via transsphenoidal route) or through Magnetic Resonance Imaging (MRI).

  • It can sometimes be mistaken for a pituitary adenoma (benign tumour) on an MRI scan.

    [1] [3].

Changes to Pituitary Hormones

  • Lymphocytic Hypophysitis may cause pituitary hormone deficiencies (too little) or hormone excesses (too much). You can read more about hormones here.

  • For example, some mothers may produce too much breast milk if there is an excess of the hormone prolactin.

  • Alternately, a mother may have difficulty producing breast milk if there is too little prolactin released.

  • Mothers may experience diabetes insipidus if there is a deficiency in Anti-Diuretic Hormone (ADH).

  • These hormone excesses or deficiencies may spontaneously recover or require long term hormone replacement if the pituitary cells have been damaged.

  • Hypopituitarism is the term given to hormone deficiencies following damage to the pituitary gland.

    [3]

Acute Illness

  • Some women discover they have Lymphocytic Hypophysitis after experiencing an acute presentation described above.

  • Some women discover their Lymphocytic Hypophysitis later, when their hypopituitarism is detected following an acute adrenal crisis. You can find information about keeping yourself safe with adrenal insufficiency here.

  • It can be a real shock to become very unwell at any time of your life. You can find understanding here around recovering from acute illness.