Getting to the heart of hypopituitarism
Editor – In the reported case of the association of panhypopituitarism, empty sella and pericardial effusion,1 autoimmune hypophysitis (AH) might have been the underlying basis for all three derangements. Firstly, empty sella may be the eventual outcome of AH.2,3 Secondly, AH is an example of type 2 autoimmune polyglandular syndrome(APS-2),4 which is now recognised as sometimes having serositis as a non-endocrine manifestation.4 In one patient with AH, pericardial effusion was an example of the coexistence of serositis and APS-2.3 In that 37-year-old woman, serial magnetic resonance imaging studies during 2-year follow-up showed an atrophic pituitary gland with empty sella turcica.3
Serositis was exemplified by pericardial effusion (with tamponade) in a 34-year-old woman in whom the endocrine component of APS-2 consisted of the coexistence of primary hypoadrenalism and primary hypothyroidism. Following pericardiocentesis, despite good compliance with hormone replacement therapy, she experienced seven documented recurrences of pericarditis over a period of 28 months,5 testifying to the observation that serositis may recur after asymptomatic intervals of months or years even in patients treated for endocrine dysfunction.6 Accordingly, in APS-2 the evolution of serositis does not necessarily parallel the evolution of endocrine dysfunction, and adequacy of replacement therapy does not guarantee freedom from recurrences of serositis.
Conflicts of interest
The author has no conflicts of interest to declare.
- © Royal College of Physicians 2017. All rights reserved.
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