HIPOFISITIS

Dra. Fanny Elizabeth Juregui Rodrguez R3E

 HIPOFISITIS
Es caracterizado por la inflamacin
e infiltracin celular en la glndula
pituitaria (aguda o crnica),
generalmente por una enfermedad
autoinmunitaria. Incidencia estimada
Enfermedad rara
1: 7-9000,000

1% de las tumoraciones
quirrgicas

John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
 HIPOFISITIS
Clasificacin:
-Etiologa
-Morfologa
-Histopatologa

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
 Etiologa

Anti-GH

Anti-POMC

Ipilimumab
17%
Tremelimumab

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
 IMPROVED SURVIVAL WITH IPILIMUMAB
IN PATIENTS WITH METASTATIC MELANOMA.
N ENGL J MED 2010

John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
 Etiologa

John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
 ANATMICO

Panhipofisitis

Adenohipofisitis Infundibuloneurohipofisitis

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
HISTOPATOLGICO

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
 MANIFESTACIONES CLNICAS MS
COMUNES

Trastornos visuales
compresin del nervio ptico
Expansin de la masa sellar
y pares craneales III, IV y VI

Cefalea 50% Hipopituitarismo

Diabetes inspida Prolactina

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
 MANIFESTACIONES CLNICAS RARAS

Compresin carotidea Apopleja

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
 EJES HORMONALES

Corticotropo Tirotropo

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
 DIAGNSTICO

Resonancia magntica
Crecimiento homogneo

Aumento homogneo de la Prdida del "punto brillante"

glndula pituitaria neurohipfisis

Simtrica difusa Hipointensidad T2

Engrosamiento difuso del tallo

pituitario
Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
DIAGNSTICO

Anticuerpos antipituitaria
y antihipotalamo

Poco sensibles y especficos

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
DIAGNSTICO

Biopsia

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32
 TRATAMIENTO

Clnica de compresin La terapia con glucocorticoides en dosis altas se considera el

Efecto de masa tratamiento de eleccin en pacientes con sntomas:
Deterioro visual -Prednisolona 60-100 mg/day
Oftalmopleja -Metilprednisolona 500-1000 mg daily IV
Sntomas severos -6-8 semanas
Falla al tratamiento con esteroides
Responden 65-100% Deterioro hormonal 18%

Recurrencia 38%
Ciruga

Falla o efectos secundarios del tratamiento

-Disminucin tumoracin: 68-

100%
-Cefalea 82%
-Mejora visin 78% Azatioprina 100-200 mg/d solo o en combinacin GC
-Mejora PC 100% Metotrexate
Ciclosporina A
Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
Deterioro hormonal 11-40% Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
 Neuritis ptica que no respondi a otros frmacos inmunosupresores

Rituximab y/o tratamiento secuencial con infliximab

Presencia de galactorrea

Bromocriptina

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
 TRATAMIENTO

Clnica de compresin La terapia con glucocorticoides en dosis altas se considera el

Efecto de masa tratamiento de eleccin en pacientes con sntomas:
Deterioro visual -Prednisolona 60-100 mg/day
Oftalmopleja -Metilprednisolona 500-1000 mg daily IV
Sntomas severos -6-8 semanas
Falla al tratamiento con esteroides
Recurrencia 38%
Responden 65-100% Deterioro hormonal 18%

Ciruga

Fracaso de la ciruga y glucocorticoides

Radioterapia fraccionada
con dosis de 15-56 Gy
Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
Zuleyha KARACA, Fahrettin, The management of hypophysitis, Minerva Endocrinologica 2016 September;41(3):390-9
TRATAMIENTO

Alexander Faje, Hypophysitis: Evaluation and Management, Faje Clinical Diabetes and Endocrinology (2016) 2:15
John D. Carmichael, Update on the diagnosis and management of hypophysitis, Curr Opin Endocrinol Diabetes Obes 2012, 19:314 32