Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan's syndrome

Annamaria De Bellis, Fahrettin Kelestimur, Antonio Agostino Sinisi, Giuseppe Ruocco, Gilda Tirelli, Marina Battaglia, Giuseppe Bellastella, Giovanni Conzo, Fatih Tanriverdi, Kursad Unluhizarci, Antonio Bizzarro, Antonio Bellastella
2008 European Journal of Endocrinology  
ObjectiveWhile anti-pituitary antibodies (APAs) were detected in some patients with Sheehan's syndrome (SS) suggesting an autoimmune pituitary involvement in the development of their hypopituitarism, hypothalamic cell anti-hypothalamus antibodies (AHAs) have not been investigated so far.DesignThe aim of this study was to evaluate the presence of AHA and APA in SS patients to verify whether an autoimmune hypothalamic–pituitary process can contribute to their late hypopituitarism.MethodsTwenty
more » ... en with SS with a duration of disease ranging from 3 to 40 years (median 25.5 years) were enrolled into the study. Out of 20 patients, 12 (60%) had panhypopituitarism and the others had partial hypopituitarism well corrected with appropriate replacement therapy. None of them had clinical central diabetes insipidus. AHA and APA were investigated by immunofluorescence method in all patients. In addition, a four-layer immunofluorescence method was used to verify whether AHA immunostained vasopressin-secreting cells (AVP-c) or not.ResultsAHAs were found in 8 out of 20 (40%) and APAs in 7 out of 20 (35%) patients with titers ranging from 1:32 to 1:128 and 1:16 to 1:32 respectively; however, in none of these positive patients AHA immunostained vasopressin cells. None of controls resulted positive for both antibodies.ConclusionsPatients with SS, even many years after the onset of SS, can show antibodies to pituitary and/or hypothalamic but not AVP-secreting cells. Antibodies to unknown hypothalamic cells (releasing factor-secreting cells) other than APAs suggest that an autoimmune process involving both the hypothalamus and pituitary gland may contribute to late pituitary dysfunction in SS patients.
doi:10.1530/eje-07-0647 pmid:18230820 fatcat:dpmyvmd5vzfnjafwsxzpx5lkgm