Document Detail

Predictive role of the immunostaining pattern of immunofluorescence and the titers of antipituitary antibodies at presentation for the occurrence of autoimmune hypopituitarism in patients with autoimmune polyendocrine syndromes over a five-year follow-up.
MedLine Citation:
PMID:  20501686     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Antipituitary antibodies (APA) are frequently present in patients with autoimmune polyendocrine syndrome (APS). DESIGN: The aim was to evaluate the predictive value of APA for the occurrence of hypopituitarism. A total of 149 APA-positive and 50 APA-negative patients with APS and normal pituitary function were longitudinally studied for 5 yr. METHODS: APA, by indirect immunofluorescence, and anterior pituitary function were assessed yearly in all patients. The risk for developing autoimmune pituitary dysfunction was calculated using survival and multivariate analysis. RESULTS: Hypopituitarism occurred in 28 of 149 (18.8%) APA-positive patients but in none of the 50 APA-negative patients. The immunostaining pattern in APA-positive patients involved either isolated pituitary cells [type 1 pattern; n=99 (66.4%)] or all pituitary cells [type 2 pattern; n=50 (33.6%)]. All patients developing pituitary dysfunction throughout the study span had a type 1 pattern. Kaplan-Meier curves for cumulative survival showed a significantly higher rate for developing hypopituitarism in relation to positive APA tests (P<0.005), pattern of immunostaining (P<0.0001), and APA titers (P<0.000001). Cox regression analysis in APA-positive patients with a type 1 pattern demonstrated a significantly (P<0.0001) higher risk for the onset of hypopituitarism in relation to increasing titers of APA. CONCLUSIONS: APA measurement by immunofluorescence may help to predict the occurrence of hypopituitarism but only when considering the immunostaining pattern and their titers. Combined evaluation of these parameters allows identifying patients at higher risk for pituitary autoimmune dysfunction, thus requiring a strict pituitary surveillance to disclose a preclinical phase of hypopituitarism and possibly interrupt therapeutically the progression to clinically overt disease.
Giuseppe Bellastella; Mario Rotondi; Elena Pane; Assunta Dello Iacovo; Barbara Pirali; Liliana Dalla Mora; Alberto Falorni; Antonio Agostino Sinisi; Antonio Bizzarro; Annamaria Colao; Luca Chiovato; Annamaria De Bellis;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-05-25
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  95     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-05     Completed Date:  2010-08-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3750-7     Citation Subset:  AIM; IM    
Department of Clinical and Experimental Medicine and Surgery, F. Magrassi, A. Lanzara, Second University of Naples, via Pansini N. 5, 80131 Naples, Italy.
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MeSH Terms
Autoantibodies / immunology*
Fluorescent Antibody Technique
Hypopituitarism / complications,  diagnosis*,  immunology*
Pituitary Gland, Anterior / immunology
Polyendocrinopathies, Autoimmune / complications,  immunology*
Predictive Value of Tests
Regression Analysis
Statistics, Nonparametric
Reg. No./Substance:
M R Ambrosio / ; E Arvat / ; P Beck-Peccoz / ; C Betterle / ; S Cannavò / ; E Degli Uberti / ; R Giordano / ; E Ghigo / ; G Lombardi / ; M Maghnie / ; F Mantero / ; L Persani / ; A Spada / ; F Santeusanio / ; M Delvecchio /

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