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Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system

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Abstract

Purpose

Hypophysitis can clinically and radiologically mimic other nonfunctioning masses of the sella turcica, complicating preoperative diagnosis. While sellar masses may be treated surgically, hypophysitis is often treated medically, so differentiating between them facilitates optimal management. The objective of our study was to develop a scoring system for the preoperative diagnosis of hypophysitis.

Methods

A thorough literature review identified published hypophysitis cases, which were compared to a retrospective group of non-functioning pituitary adenomas (NFA) from our institution. A preoperative hypophysitis scoring system was developed and internally validated.

Results

Fifty-six pathologically confirmed hypophysitis cases were identified in the literature. After excluding individual cases with missing values, 18 hypophysitis cases were compared to an age- and sex-matched control group of 56 NFAs. Diabetes insipidus (DI) (p < 0.001), infundibular thickening (p < 0.001), absence of cavernous sinus invasion (CSI) (p < 0.001), relation to pregnancy (p = 0.002), and absence of visual symptoms (p = 0.007) were significantly associated with hypophysitis. Stepwise logistic regression identified DI and infundibular thickening as positive predictors of hypophysitis. CSI and visual symptoms were negative predictors. A 6-point hypophysitis-risk scoring system was derived: + 2 for DI, + 2 for absence of CSI, + 1 for infundibular thickening, + 1 for absence of visual symptoms. Scores ≥ 3 supported a diagnosis of hypophysitis (AUC 0.96, sensitivity 100%, specificity 75%). The scoring system identified 100% of hypophysitis cases at our institution with an estimated 24.7% false-positive rate.

Conclusions

The proposed scoring system may aid preoperative diagnosis of hypophysitis, preventing unnecessary surgery in these patients.

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Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Code availability

Not applicable to this study.

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Acknowledgements

Juliana Magro (librarian) for assistance with the database search.

Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. NYU Grossman School of Medicine, NYU Langone Health, 1st Ave, New York, NY, 10016, USA

    Kyla Wright

  2. Division of Endocrinology, Metabolism and Nutrition, Rutgers-Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ, 0890, USA

    Hyon Kim

  3. Department of Neurosurgery, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA

    Travis Hill & Cordelia Orillac

  4. Department of Radiology, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA

    Matthew Lee

  5. Department of Medicine, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA

    Nikita Mogar

  6. Department of Neurosurgery, NYU Langone Medical Center, 530 1st Ave Skirball Suite 8R, New York, NY, 10016, USA

    Donato Pacione

  7. Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, 550 1st Avenue, New York, NY, 10016, USA

    Nidhi Agrawal

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  1. Kyla Wright
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Correspondence to Nidhi Agrawal.

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Conflicts of interest

KW, HK, TH, ML, CO, NM, and DP have nothing to disclose. NA is on the advisory board for Corcept Therapeutics and is a Principal Investigator for institution-directed research grants (Chiasm Acromegaly Registry).

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PubMed Search Details

Date searched: 10/20/2020 – no date limits were applied.

Total results: 932.

Keywords:

("stalk lesion"[Text Word] OR "stalk lesions"[Text Word] OR "pituitary stalk"[Text Word] OR "Hypophysitis"[MeSH Terms] OR "Hypophysitis"[Text Word] OR "Hypophysitides"[Text Word] OR "pituitary inflammation"[Text Word]) AND ("pituitary gland/surgery"[MeSH Terms] OR "pituitary neoplasms/surgery"[MeSH Terms] OR "Neurosurgical Procedures"[MeSH Terms] OR "pituitary diseases/surgery"[MeSH Terms] OR "surgical procedures, operative"[MeSH Terms] OR "Neurosurgical Procedure"[Text Word] OR "Neurosurgical Procedures"[Text Word] OR "Neurologic Surgical Procedures"[Text Word] OR "Surgery"[Text Word] OR "Surgeries"[Text Word] OR "pituitary surgery"[Text Word] OR "pituitary surgeries"[Text Word] OR "transsphenoidal surgery"[Text Word] OR "surgical"[Text Word] OR "surgically"[Text Word]).

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Wright, K., Kim, H., Hill, T. et al. Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system. Pituitary 25, 602–614 (2022). https://doi.org/10.1007/s11102-022-01232-0

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