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Prevalence and Functional Significance of Antipituitary Antibodies in Patients with Autoimmune and Non-Autoimmune Thyroid Diseases

Departments of Endocrinology (L.M., I.L., L.L.M., S.A., L.G., M.G., F.B., E.M.) and Neuroscience (M.C.), University of Pisa, 56124 Pisa, Italy; Endocrinology Unit, Department of Medical Sciences "M. Aresu" (G.P., S.M.), San Giovanni di Dio Hospital, University of Cagliari, 09042 Cagliari, Italy; and Department of Clinical Medicine (L.B.), University of Insubria, 21100 Insubria, Italy

Address all correspondence and requests for reprints to: Dr. Luca Manetti, Dipartimento di Endocrinologia, Università di Pisa, Ospedale Cisanello, via Paradisa, 2, 56124 Pisa. E-mail: lmanetti{at}endoc.med.unipi.it.

Background: Circulating antipituitary antibodies (APA) are markers of autoimmune hypophysitis, which may cause deficient pituitary function. The prevalence of APA in autoimmune thyroid disorders (AITD) is uncertain.

Objectives: The aims of this study were 1) to evaluate APA prevalence in a large series of patients with AITD and non-AITD and 2) to investigate the functional significance of APA by assessing pituitary function in APA-positive patients.

Design and Setting: We conducted a health survey on consecutive AITD and non-AITD patients at a tertiary referral center (Department of Endocrinology, Pisa).

Patients: Subjects, including 1290 consecutive patients with thyroid disorders (961 AITD and 329 non-AITD) and 135 controls, were enrolled in the study.

Methods: APA (indirect immunofluorescence), free T₄, free T₃, TSH, and organ-specific autoantibodies were assayed in all patients. Functional pituitary evaluation was performed in most APA-positive patients.

Results: APA frequency was higher in AITD (11.4%) than in non-AITD (0.9%; P < 0.0001) patients; all control subjects had negative APA tests. APA were more frequently found in Hashimoto’s thyroiditis (13%) than in Graves’ disease (7.1%; P = 0.05). Of 110 APA-positive AITD patients, 20 (18.2%) had autoimmune polyglandular syndrome, whereas 90 (81.8%) had apparently isolated AITD. APA positivity increased percentage of autoimmune polyglandular syndrome in our series from 10.4 to 13.5%. Of 110 APA-positive patients, 102 were submitted to dynamic testing for functional pituitary assessment; 36 patients (35.2%) had mild or severe GH deficiency (GHD). No additional anterior pituitary hormone deficiencies were found; one patient had central diabetes insipidus. Pituitary abnormalities at magnetic resonance imaging were found in most APA-positive GHD patients.

Conclusions: APA are frequently present in patients with AITD. Patients should be tested for APA because positive tests are associated with GHD.

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