After the diagnosis
Because of the only recent improvement in understanding of autoimmune hypophysitis, a small number of cases have been identified before a surgery approach. For this reason it is difficult to suggest a flow-chart of therapy, prognosis and follow-up.

Sometimes autoimmune hypophysitis tends to recover spontaneously without any treatment. There is no absolute agreement among endocrinologists about the best therapy. Because of the autoimmune-inflammatory nature of the pituitary enlargement, corticosteroids are the most common medication used. The goal of the therapy is first to decrease the gland and relieve the compression on the dura mater and optic chiasma. Corticosteroids have also immunosuppressive effect, and their use can reduce the autoimmune reaction in the gland. Because a persistent damage (and the consequent functional deficiency) depends on the percentage of normal tissue that has been substituted by fibrosis, the therapy needs to be begun as fast as possible.

The prognosis is quite variable. In fact a wide number of variables can interfere with that: the grade of autoimmune infiltration in the gland, the percentage of fibrosis, the correct response to corticosteroids or the local compressive effects. The prognosis is usually good: the visual defect tends to recover when the gland decreases in size and also headache disappears at that time. Functional impairments are more frequent than persistent visual defects, but fortunately they can be treated by hormone replacement therapy. Levo-thyroxine is used to replace the thyroid function, glucocorticoid and mineralcorticoid are available to treat the adrenal insufficiency and recombinant GH is today obtainable to replace the somatotrophs function. Different problems can happen when the gonadotrophs cells are affected. In fact, although commercial androgens and female hormones are available, they are not capable to treat completely the gonadal insufficiency. In fact, estrogen and progesterone (HRT), alone or in concert with alendronates (or raloxifene in those woman in which estrogen is not indicated), are useful medications for preventing loss of bone mass in menopausal woman, but they does not recover the infertility in young woman. Androgen in different preparation, are also available to treat males affected by impotence derived from gonadotrophs insufficiency. Although steroids are commonly in use, sometimes men refer difficulties in sexual relations, and some of them do not find again fertility.

After the therapy has been posed, the disease needs to be followed-up. The timing and the way vary by case. For example, in those subjects with a complete (anatomical and functional) recover it is necessary only a periodical endocrinological examination. If the recover is partial, the patients needs to be enrolled in a specific program to check the pituitary function (by hormone measurements for example) and the local situation (by imaging or optician examination). In some patients, especially in those with a history of autoimmune diseases, we suggest also to perform a general autoimmune evaluation, checking the most common markers of autoimmune disease.