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Léa Miquel, Benoit Testud, Frederic Castinetti, Letter to the editor: “Primary” hypophysitis and the benefits of glucocorticoids, a still unresolved question, European Journal of Endocrinology, Volume 192, Issue 1, January 2025, Pages L1–L2, https://doi.org/10.1093/ejendo/lvae164
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Comment on “Evaluation and follow-up of patients diagnosed with hypophysitis: a cohort study” by Hacioglu et al. doi:https://doi.org/10.1093/ejendo/lvae101.
Dear Editor,
We read with interest the manuscript “Evaluation and follow-up of patients diagnosed with hypophysitis: a cohort study” by Hacioglu et al.1 The aim of this study was to better characterize the characteristics, management, and outcome of primary hypophysitis based on a large multicenter study of 113 patients. The main conclusion was that glucocorticoids led to improved hormonal and radiological outcomes, a result that remains controversial compared with previous literature data. However, we have some concerns regarding the diagnosis of primary hypophysitis and the conclusions that should be drawn regarding the benefit of glucocorticoids.
First, we found some discrepancies in the definition of “primary” hypophysitis. While the diagnosis was made retrospectively on questionnaires for the majority of patients, one patient with Igg4 hypophysitis and another with Sjögren's disease were diagnosed as having primary hypophysitis, whereas these should be considered secondary hypophysitis.2,3 Sixteen patients presented with granulomatous hypophysitis but apparently did not have an exhaustive and systematic workup for systemic sarcoidosis, including at least chest CT, cerebrospinal fluid by lumbar puncture, and then a fluorodeoxyglucose positron emission tomographic scan.4,5 As recently emphasized in our single-center study based on 61 patients, secondary causes of hypophysitis often appear during follow-up, sometimes several years later.6 Systematic evaluation for these secondary causes should be performed and repeated over time. A limitation of our study was that the follow-up of some patients could be considered insufficient to exclude a secondary cause, and this is also a limitation seen in the work of Hacioglu et al. Given the rarity of this condition and the large number of patients recruited in this multicenter study, we believe that a more complete workup and a precise description of the evolution of these patients could be of great help in establishing the diagnosis of primary hypophysitis, and consider the results of management especially in these cases.
