Abstract

 Lymphocytic or autoimmune hypophysitis (AH) is a rare disorder characterized by inflammation of the pituitary gland. There is no consensus on treatment, but may include corticosteroid therapy and decompression surgery. Optic neuritis (ON) is an inflammation of the optic nerve, both of unknown etiology and autoimmune hypothesis. The association of pathologies is rare, with few reports in the literature. The diagnosis of ON is clinical and treatment with high dose corticosteroids. A case initially diagnosed as ON with pituitary macroadenoma is described: 55-year-old woman with sudden bilateral visual loss associated with nausea, vomiting, diarrhea and hypotension, MRI with pituitary expansive lesion with optic chiasm compression and laboratory tests showing thyrotrophic, corticotrophic and gonadotropic axes deficiencies, associated with mild hyperprolactinemia. Methylprednisolone pulse therapy was performed for ON treatment. Patient presented improvement of visual acuity, decreased pituitary volume and recovery of corticotrophic axis, raising the hypothesis of AH. The case demonstrates the importance of careful neuro-ophthalmologic and radiographic evaluation of patients with pituitary adenoma and visual loss. NO and AH should be considered in the differential diagnosis as this may prevent unnecessary invasive procedures.

Keywords: Autoimmune Hypophysitis; Optic Neuritis; Pituitary Diseases; Hypopituitarism

References

1. Rivera J. “Lymphocytic hypophysitis: Disease spectrum and approach to diagnosis and therapy”. Pituitary 1 (2006): 35-45.
2. Caturegli P., et al. “Autoimmune Hypophysitis”. Endocrine Reviews 5 (2005): 599-614.
3. Paiva I., et al. “Hipofisite Auto-imune ou Linfocitica”. Acta Medica Portuguesa (2003).
4. Dhooria B., et al. “A case of hypophysitis in a young male patient”. Medical Journal Armed Forces India 1 (2018): 89-92.
5. Iuliano S and Laws E. “The diagnosis and management of lymphocytic hypophysitis”. Expert Review of Endocrinology and Metabolism 6 (2011): 777-783.
6. Kristof R., et al. “Lymphocytic hypophysitis: non-invasive diagnosis and treatment by high dose methylprednisolone pulse therapy?” Journal Neurology Neurosurgery Psychiatry 3 (1999): 398-402.
7. Gal R., et al. “Corticosteroids for treating optic neuritis”. Cochrane Database of Systematic Reviews 8 (2015): CD001430.
8. “The Clinical Profile of Optic Neuritis”. Archives of Ophthalmology 12 (1991):1673.
9. Sellner, J., et al. “EFNS guidelines on diagnosis and management of neuromyelitis optica”. European Journal of Neurology 8 (2010): 1019-1032.
10. Zoeller G., et al. “Lymphocytic hypophysitis in a patient presenting with sequential episodes of optic neuritis”. Pituitary 1 (2010): 101-105.
11. Pena J., et al. “Lymphocytic Hypophysitis Associated With Pediatric Multiple Sclerosis”. Pediatric Neurology 4 (2014): 580-582.
12. Tamiya N Saeki and A Mizota A. “Lymphocytic infundibulo-neurohypophysitis associated with recurrent optic neuritis”. British Journal of Neurosurgery 2 (2001):180-183.
13. Saito S., et al. “A case of optic neuritis associated with lymphocytic hypophysitis revealed by pattern-reversal VEP”. Rinsho Shinkeigaku 1 (2011): 27-31.
14. Imura H., et al. “Lymphocytic Infundibuloneurohypophysitis as a Cause of Central Diabetes Insipidus”. New England Journal of Medicine 10 (1993): 683-689.
15. Al-Mujaini A., et al. “Lymphocytic infundibulo-neurohypophysitis: An unusual cause of recurrent optic neuropathy in a child”. Journal of American Association for Pediatric Ophthalmology and Strabismus, 13.2 (2009): 207-209.
16. Xu C., et al. “Autoimmune lymphocytic hypophysitis in association with autoimmune eye disease and sequential treatment with infliximab and rituximab”. Pituitary 4 (2014): 441-447.

Citation

Citation: Lucas Ribeiro dos Santos. “Optic Neuritis and Hypophysitis: Partial Remission after Pulse Therapy".Acta Scientific Neurology 3.4 (2020): 01-04.

Copyright

Copyright: © 2020 Lucas Ribeiro dos Santos. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.