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Median Eminence Dopaminergic Nerve Terminals: A Novel Target in Autoimmune Polyendocrine Syndrome?

NEF-Laboratory, Department of Cytomorphology (C.C., G.-L.F.) and Endocrinology, Department of Medical Science (F.B., G.P., S.M.), University of Cagliari at Monserrato, 09042 Monserrato (Cagliari), Italy; Clinica Pediatrica II, Department of Biomedical Biotechnological Science (A.M.), University of Cagliari, 09100 Cagliari, Italy; and Department of Neuroscience (R.P.), Tor Vergata University, 00133 Rome, Italy

Address all correspondence and requests for reprints to: Prof. Gian-Luca Ferri, M.D., Department of Cytomorphology, Cittadella Universitaria, 09042 Monserrato (Cagliari), Italy. E-mail: ferri{at}unica.it.

Context: Autoantibodies to adenohypophyseal endocrine cells or to vasopressin neurohypophyseal neurons have long been known. Conversely, autoimmune targeting of further hypothalamic-hypophyseal structures, such as the blood-brain barrier-deprived median eminence, has been little studied.

Objective and Methods: We studied a case of autoimmune polyendocrine syndrome type I with GH secretory deficiency, a distinctly rare event in autoimmune polyendocrine syndrome type I. We used rat and bovine tissue substrates to study autoantibodies against hypothalamic-hypophyseal nerve structures and endocrine cells.

Results: In the study case, circulating autoantibodies selectively decorated median eminence dopaminergic nerve terminals, as well as pituitary gonadotropes, but not GHRH nerve terminals or pituitary somatotropes. Such autoantibodies appeared de novo in parallel with the onset of GH secretory deficiency, whereas no median eminence labeling was found in patients suffering of idiopathic GH deficiency (n = 7) or in healthy controls (n = 23).

Conclusions: The pathophysiological significance of our patient’s autoantibodies remains to be confirmed. Nonetheless, the heterogeneous neuroendocrine structures of the median eminence are pointed out as potential immune targets, relevant to autoimmune polyendocrinopathy, as well as to a wide range of other conditions.

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