Clinical presentation, investigation findings, and outcomes of hypophysitis in sarcoidosis: a systematic review
Authors' conclusion
Hypophysitis in sarcoidosis should be suspected in patients presenting with stalk thickening, sellar lesions, AVP deficiency, or unexplained hypogonadism.
Study context
- Population
- Adults with sarcoidosis-related hypophysitis; PubMed, Embase and Scopus searched from inception to January 22, 2025
- Participants
- 274 adults166 studies
- Outcome
- Clinical presentation, investigation findings and outcomes
Methodological detailscases reassessed by 2018 Neurosarcoidosis Consortium Consensus Group criteria, sensitivity analyses (definite/probable cohort; publication era)
- Cases reassessed by 2018 Neurosarcoidosis Consortium Consensus Group criteria
- Sensitivity analyses (definite/probable cohort; publication era)
Pooled result
As reported in the abstract
- Diagnostic certainty definite
- 26.3%
- Diagnostic certainty probable
- 47.8%
- Diagnostic certainty possible
- 25.9%
- Median age, years (IQR 28-48)
- 37
- Male
- 53.5%
- AVP-D (most frequent manifestation)
- 53.6%
- Gonadal dysfunction
- 38.3%
- Visual loss
- 36.1%
- Headache
- 32.2%
- Fatigue
- 30.5%
- Central hypogonadism (most common anterior pituitary abnormality)
- 74.1%
- Central hypothyroidism
- 63.6%
- Hyperprolactinemia
- 58.1%
- MRI: pituitary stalk thickening
- 43.1%
- MRI: sellar/suprasellar masses
- 36.4%
- CSF: elevated protein
- 68.9%
- CSF: pleocytosis
- 59.5%
- Systemic involvement (mainly lymph nodes and lungs)
- 80.3%
- Recurrence (corticosteroids mainstay of treatment)
- 43.1%
- Chronic hormone replacement required
- 36.2%
- Long-term desmopressin dependence
- 30.5%
Further pooled results
Sensitivity analyses: definite/probable cohort and publication eras (1954-1999, 2000-2017, 2018-2024)
- Findings materially unchanged in definite/probable cohort (n = 203) and across publication eras, despite increased MRI use and greater adoption of steroid-sparing and biologic therapies over time
Original publication
Clinical presentation, investigation findings, and outcomes of hypophysitis in sarcoidosis: a systematic review. Pituitary. Published 20 August 2026. doi:10.
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