Lupus‑Associated Hypophysitis: A Narrative Systematic Review of Clinical, Radiological and Endocrine Features
Abdellatif Zhalka, Shadi Shinnawi, Rami Jabareen, Awad Karem, Muhammad ZahlakaABSTRACT
Background
Lupus‐associated hypophysitis is a rare but clinically important manifestation of systemic lupus erythematosus (SLE), characterised by heterogeneous pituitary dysfunction and inflammatory sellar changes that may mimic other pituitary disorders. Evidence is limited to isolated reports. We aimed to summarise clinical, radiological, endocrine features, management, and outcomes.
Methods
A narrative systematic review of MEDLINE, Embase, Web of Science, and Google Scholar to 10 November 2025. Reports were included if accepted SLE criteria were met and hypophysitis or hypothalamic–pituitary inflammation was attributed to SLE after exclusion of alternative sellar pathology. Demographic, clinical, endocrine, imaging, treatment, and outcome data were synthesised descriptively.
Results
Eleven cases (63% female; median age 23 years) were identified, most presenting at or near SLE diagnosis. Common symptoms included polyuria/polydipsia, fatigue, amenorrhoea, and headache. Arginine vasopressin deficiency (AVP‐D) frequently coexisted with multi‐axis anterior hypopituitarism. MRI typically demonstrated pituitary stalk thickening, gland enlargement, and loss of the posterior pituitary bright spot. High‐dose glucocorticoids, with or without additional immunosuppression, led to improvement in most cases, although persistent adrenal and gonadal deficits were common; one patient died from severe hyponatraemia.
Conclusions
Lupus‐associated hypophysitis is a rare manifestation of SLE with heterogeneous endocrine and radiological presentations that may create diagnostic challenges. Early endocrine evaluation and pituitary imaging are important in patients with suspected hypothalamic‐pituitary involvement.