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Chair of Endocrinology, Department of Clinical and Experimental Medicine and Surgery "F. Magrassi, A. Lanzara," Second University of Naples, 80131 Naples, Italy
Address all correspondence and requests for reprints to: Annamaria De Bellis, M.D., Istituto di Endocrinologia, Seconda Università di Napoli, via Pansini N. 5, 80131 Napoli, Italy. E-mail: annamaria.debellis{at}unina2.it.
The role of antipituitary antibodies (APA) in autoimmune pituitary diseases still needs to be clarified. The aim of this study was 2-fold: first, to investigate the presence of APA in adults with idiopathic or acquired GH deficiency (GHD) and in adults with autoimmune endocrine diseases; and second, to evaluate whether in autoimmune endocrine patients APA titer is correlated to the pituitary function and particularly to GH secretion. We studied 12 adults with isolated and apparently idiopathic GHD who were treated with recombinant GH in childhood (group 1a), 14 patients with adult GHD secondary to surgery for pituitary and parasellar tumors (group 1b), and 180 patients with organ-specific autoimmune diseases (group 2). APA were evaluated by indirect immunofluorescence. In all APA-positive patients and in 20 APA-negative patients of group 2, GH secretion was investigated by testing its response to insulin-induced hypoglycemia (insulin tolerance test) and, when impaired, also to arginine.
APA were found (at high titers) in 4 of 12 patients of group 1a (33.3%) but were absent in all patients in group 1b. APA were also found in 40 of 180 patients of group 2 (22.2%), 35 of them at low titers (group 2a) and 5 at high titers (group 2b). Twenty of the 140 autoimmune endocrine APA-negative patients studied (group 2c) and all APA-positive patients at low titers (group 2a) had normal pituitary function. Conversely, all APA-positive patients at high titers (groups 1a and 2b) had a severe isolated GHD. An inverse correlation between APA titers and GH peak serum response to insulin tolerance test in autoimmune endocrine patients was observed.
Our results suggest that APA, when detected at high titers, may be considered a good diagnostic tool to highlight the possible occurrence of GHD in adults with autoimmune endocrine diseases. Moreover, they may indicate an autoimmune pituitary involvement in adults with apparently idiopathic GHD, suggesting that the prevalence of autoimmune GHD is much higher than that so far considered.
This work was supported in part by grants from Ministero Università Ricerca Scientifica e Tecnologica (PRIN 20011063439-003 to A.Be.).
A.D.B. and A.Bi. contributed equally to the manuscript.
Abbreviations: APA, Antipituitary antibodies; BMI, body mass index; CDI, central diabetes insipidus; GHD, GH deficiency; ITT, insulin tolerance test; LADA, latent autoimmune diabetes in adults; MRI, magnetic resonance imaging; PRL, prolactin.
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