[Importance of long-term follow-up of diabetes insipidus; from lymphocytic hypophysitis to germinoma]. / Importancia del seguimiento a largo plazo de la diabetes insípida; de hipofisitis linfocitaria a germinoma.

A case is presented of a 10-year old boy who had a hypothalamic-pituitary axis disorder. He initially presented with diabetes insipidus that progressed to panhypopituitarism. A hidden hypothalamic lesion should be suspected in all these cases, and should be followed up. New lesions were found in the pituitary stem three years later. Although tumor markers were negative, there was an increase in size, and a biopsy was performed. The histopathology reported a Lymphocytic Hypophysitis. There were increases in the tumor markers during the follow-up, thus a second biopsy was performed, with the diagnosis of Germinoma. Lymphocytic Hypophysitis is an uncommon diagnosis in children. Few cases have been reported, and in some cases, they were later diagnosed with Germinoma. We believe this case highlights the importance of the follow-up of children with Central Diabetes Insipidus with a normal MRI, as well as not taking the diagnosis of Lymphocytic Hypophysitis/lymphocytic Infundibular neurohypophysitis as definitive, as it is a rare diagnosis at this age, and could mask a Germinoma, as recorded in some cases.

Hipofisitis linfocitaria: fisiopatología y utilidad de los anticuerpos antipituitarios para su diagnós / Lymphocytic Hypophysitis: Pathophysiology and Utility of Anti-Pituitary Antibodies for Diagnosis

La hipofisitis linfocitaria (HL) es un proceso autoinmune caracterizado por infiltración linfocitaria difusa de la glándula pituitaria con grados variables de destrucción. Los niveles elevados de prolactina y la caída de los estrógenos en el posparto son factores predisponentes para su desarrollo por lo que esta patología se presenta principalmente en mujeres jóvenes durante el embarazo o el puerperio. Se desconoce el antígeno implicado en su patogenia. En los últimos años se ha investigado la existencia de anticuerpos antipituitarios (APA) que permitan realizar un diagnóstico certero, de manera sencilla, con una sensibilidad y especificidad aceptables, que faciliten una adecuada interpretación clínica y un tratamiento acorde. Los autores declaran no poseer conflictos de interés.(AU)

Lymphocytic hypophysitis (HL) is an autoimmune condition characterized by diffuse lymphocytic infiltration of the pituitary gland with varying degrees of destruction. It occurs mainly in young women during pregnancy or the postpartum period secondary to elevated levels of prolactin (PRL) associated with a drop in estrogen levels in the postpartum period. The antigen involved in its pathogenesis is still unknown. In recent years, the existence of antipituitary antibodies (APA) has been investigated to allow a simple, accurate diagnosis, with acceptable sensitivity and specificity that enables an adequate clinical interpretation and treatment.(AU)

Hipofisitis linfocitaria: fisiopatología y utilidad de los anticuerpos antipituitarios para su diagnós / Lymphocytic Hypophysitis: Pathophysiology and Utility of Anti-Pituitary Antibodies for Diagnosis

La hipofisitis linfocitaria (HL) es un proceso autoinmune caracterizado por infiltración linfocitaria difusa de la glándula pituitaria con grados variables de destrucción. Los niveles elevados de prolactina y la caída de los estrógenos en el posparto son factores predisponentes para su desarrollo por lo que esta patología se presenta principalmente en mujeres jóvenes durante el embarazo o el puerperio. Se desconoce el antígeno implicado en su patogenia. En los últimos años se ha investigado la existencia de anticuerpos antipituitarios (APA) que permitan realizar un diagnóstico certero, de manera sencilla, con una sensibilidad y especificidad aceptables, que faciliten una adecuada interpretación clínica y un tratamiento acorde. Los autores declaran no poseer conflictos de interés.

Lymphocytic hypophysitis (HL) is an autoimmune condition characterized by diffuse lymphocytic infiltration of the pituitary gland with varying degrees of destruction. It occurs mainly in young women during pregnancy or the postpartum period secondary to elevated levels of prolactin (PRL) associated with a drop in estrogen levels in the postpartum period. The antigen involved in its pathogenesis is still unknown. In recent years, the existence of antipituitary antibodies (APA) has been investigated to allow a simple, accurate diagnosis, with acceptable sensitivity and specificity that enables an adequate clinical interpretation and treatment.