In your experience, how does lymphocytic hypophysitis evolve over time after initially causing permanent damage to acth-producing cells in the pituitary? does it continue to flare over the years?

Hypophysitis: Lymphocytic hypophysitismost often occurs in pregnant or recently delivered women. The inflammation is usually subacute, lasting for weeks-months, and has a fairly low risk of recurrence. However, hormone deficiencies caused by the inflammation are usually permanent. Destruction of acth-producing cells leading to low cortisol levels is the most common deficiency. Prolactin may be increased.

Generally stabilizes: Generally, this seems to stabilize. However, most of the cases that I have seen are closely monitored by endocrinologists who follow the endocrinologic manifestations very closely. This is important as most patients need supplemental hormone therapy also. The rationale for the close follow-up is also to monitor for any flare-ups which may be suppressed quickly and efficaciously with medications.

Autoimmune disease: Other endocrine deficiencies can occur, such as tsh-hypothyroidism, so this needs to be followed. Like other autoimmune conditions, it can wax/wane, but usually causes progressive fibrosis and destruction of the pituitary.