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How Hypophysitis is Diagnosed:
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The diagnosis of Autoimmune Hypophysitis (AH) is still mainly a diagnosis of exclusion. Patients often undergo surgery because they are suspected of having a pituitary adenoma. The histological exam, however, shows autoimmune hypophysitis instead. The accurate diagnosis of AH has been greatly facilitated by the introduction of magnetic resonance imaging (MRI). However, it is safe to say that no other pituitary mass lesion so consistently challenges a correct pre-operative diagnosis as AH. Of clear benefit would be the development of a screening test based on the autoimmune pathogenesis of this disease. In most of the patients reported in the literature the diagnosis was based on histology, obtained either after surgery (223) or at autopsy (26), See Table 1.
Table 1
| How Diagnosis Was Made |
# of Cases |
| Based on histology |
249 |
| Surgical pathology |
223 |
| Autopsy |
26 |
| Based on clinical and radiological criteria |
76 |
| Based on clinical criteria only |
7 |
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We believe, however, that autoimmune hypophysitis is not a surgical disease, and surgery could be avoided if the diagnosis of AH could be established without histology. Surgery should be reserved only for those cases where the pituitary mass seriously endangers the patient’s vision.
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