Mycophenolate mofetil treatment in a patient with recurrent lymphocytic hypophysitis

BMJ Case Rep. 2018 Jan 6;2018:bcr2017222678. doi: 10.1136/bcr-2017-222678.

Abstract

Lymphocytic hypophysitis (LHP) is a relatively rare disease characterised by lymphocytic infiltration of the pituitary gland, resulting in pituitary dysfunction. LHP is generally responsive to corticosteroid therapy, but cases with recurrence require clinicians to select second-line therapy. We report here the case of a 58-year-old patient with LHP who developed panhypopituitarism and bitemporal hemianopia. He responded to prednisolone 40 mg/day but relapsed during tapering. The prednisolone dose was increased again and mycophenolate mofetil (MMF) was added. Thereafter, over the course of 1 year, prednisolone was tapered to 8 mg/day without relapse. Because of the rarity of LHP, there are no standard treatment protocols that support the choice of a specific immunosuppressive drug. MMF was effective for recurrent LHP in our case. Further accumulation of cases is needed to establish the standard treatment for this disease.

Keywords: pituitary disorders; therapeutic indications.

Publication types

  • Case Reports

MeSH terms

  • Autoimmune Hypophysitis / drug therapy*
  • Drug Therapy, Combination
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Male
  • Middle Aged
  • Mycophenolic Acid / administration & dosage*
  • Prednisolone / administration & dosage*
  • Recurrence

Substances

  • Immunosuppressive Agents
  • Prednisolone
  • Mycophenolic Acid