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

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 ser...

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Veröffentlicht in:The journal of clinical endocrinology and metabolism 2007-06, Vol.92 (6), p.2176-2181
Hauptverfasser: Manetti, Luca, Lupi, Isabella, Morselli, Lisa L., Albertini, Sonia, Cosottini, Mirco, Grasso, Lucia, Genovesi, Maura, Pinna, Giovanni, Mariotti, Stefano, Bogazzi, Fausto, Bartalena, Luigi, Martino, Enio
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Sprache:eng
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Zusammenfassung: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.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2006-2748