https://orcid.org/0000-0002-6197-5659
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Aysa Hacioglu, Zuleyha Karaca, Kursad Unluhizarci, Fahrettin Kelestimur, Response to commentary: “Primary hypophysitis and the benefits of glucocorticoids, a still unresolved question”, European Journal of Endocrinology, Volume 192, Issue 1, January 2025, Pages L3–L4, https://doi.org/10.1093/ejendo/lvae165
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We would like to thank Miquel et al.1 for their comments, and for the opportunity to further discuss the methodology and the results of our study.2
Miquel et al. stated that patients diagnosed with IgG4-related hypophysitis, and Sjögren's disease should have been classified as having secondary hypophysitis. Whole body computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan revealed no other organ involvements in the patient who received the diagnosis of isolated IgG4-related hypophysitis. The patient with Sjögren's disease had no extraglandular involvement and was treated only with hydroxychloroquine until recruitment and so far. The diagnosis of hypophysitis was based on clinical and radiologic evaluation studies in the latter, and spontaneous hormonal and radiologic improvements were observed 8 months later. There is a lack of consensus across the literature if these cases should be classified as primary or secondary hypophysitis. Rare cases of IgG4-related hypophysitis which occur in isolation have been classified as primary hypophysitis, and those with multiorgan involvement have been classified as secondary by some authors3,4; however, some reports consider all cases to be secondary hypophysitis.5 Moreover, IgG4-related hypophysitis with systemic involvement was classified under both in one report.6 On the other hand, it is an ongoing topic of debate whether patients with autoimmune hypophysitis and concomitant other autoimmune diseases are to be classified as primary or secondary hypophysitis. Some authors consider autoimmune etiology as primary,3 while some others consider it as a systemic disease and classify autoimmune hypophysitis as secondary.6 The patients with various autoimmune conditions, such as Sjögren's disease, Hashimoto's thyroiditis, and Graves' disease, were classified as having primary hypophysitis in our study. Miquel et al. cited 2 references as evidence that these cases were to be classified as secondary; however, lack of consensus on this topic has been acknowledged in both papers.4,5 Moreover, there is no evidence that classifying these cases as secondary would affect the diagnostic processes or management strategies. However, it may lead to the exclusion of these patients from analyses of primary hypophysitis without scientific justification.
