Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism: Role of antibodies to hypothalamic cells

Annamaria De Bellis, A. A. Sinisi, E. Pane, A. Dello Iacovo, G. Bellastella, G. Di Scala, A. Falorni, C. Giavoli, V. Gasco, R. Giordano, M. R. Ambrosio, A. Colao, A. Bizzarro, A. Bellastella

Research output: Contribution to journalArticle

Abstract

Context: Antipituitary antibodies (APA) but not antihypothalamus antibodies (AHA) are usually searched for in autoimmune hypopituitarism. Objective: Our objective was to search for AHA and characterize their hypothalamic target in patients with autoimmune hypopituitarism to clarify, on the basis of the cells stained by these antibodies, the occurrence of autoimmune subclinical/clinical central diabetes insipidus (CDI) and/or possible joint hypothalamic contribution to their hypopituitarism. Design: We conducted a cross-sectional cohort study. Patients: Ninety-five APA-positive patients with autoimmune hypopituitarism, 60 without (group 1) and 35 with (group 2) lymphocytic hypophysitis, were studied in comparison with 20 patients with postsurgical hypopituitarism and 50 normal subjects. Main Outcome Measures: AHA by immunofluorescence and posterior pituitary function were evaluated; then AHA-positive sera were retested by double immunofluorescence to identify the hypothalamic cells targeted by AHA. Results: AHA were detected at high titer in 12 patients in group 1 and in eight patients in group 2. They immunostained arginine vasopressin (AVP)-secreting cells in nine of 12 in group 1 and in four of eight in group 2. All AVP cell antibody-positive patients presented with subclinical/clinical CDI; in contrast, four patients with GH/ACTH deficiency but with APA staining only GH-secreting cells showed AHA targeting CRH- secreting cells. Conclusion: The occurrence of CDI in patients with lymphocytic hypophysitis seems due to an autoimmune hypothalamic involvement rather than an expansion of the pituitary inflammatory process. To search for AVP antibody in these patients may help to identify those of them prone to develop an autoimmune CDI. The detection of AHA targeting CRH-secreting cells in some patients with GH/ACTH deficiency but with APA targeting only GH-secreting cells indicates that an autoimmune aggression to hypothalamus is jointly responsible for their hypopituitarism.

Original languageEnglish
Pages (from-to)3684-3690
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number10
DOIs
Publication statusPublished - Oct 2012

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Hypopituitarism
Autoimmunity
Hypothalamus
Antibodies
Neurogenic Diabetes Insipidus
Medical problems
Arginine Vasopressin
Adrenocorticotropic Hormone
Fluorescent Antibody Technique
Aggression
Type 1 Diabetes Mellitus

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

De Bellis, A., Sinisi, A. A., Pane, E., Dello Iacovo, A., Bellastella, G., Di Scala, G., ... Bellastella, A. (2012). Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism: Role of antibodies to hypothalamic cells. Journal of Clinical Endocrinology and Metabolism, 97(10), 3684-3690. https://doi.org/10.1210/jc.2012-2269

Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism : Role of antibodies to hypothalamic cells. / De Bellis, Annamaria; Sinisi, A. A.; Pane, E.; Dello Iacovo, A.; Bellastella, G.; Di Scala, G.; Falorni, A.; Giavoli, C.; Gasco, V.; Giordano, R.; Ambrosio, M. R.; Colao, A.; Bizzarro, A.; Bellastella, A.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 10, 10.2012, p. 3684-3690.

Research output: Contribution to journalArticle

De Bellis, A, Sinisi, AA, Pane, E, Dello Iacovo, A, Bellastella, G, Di Scala, G, Falorni, A, Giavoli, C, Gasco, V, Giordano, R, Ambrosio, MR, Colao, A, Bizzarro, A & Bellastella, A 2012, 'Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism: Role of antibodies to hypothalamic cells', Journal of Clinical Endocrinology and Metabolism, vol. 97, no. 10, pp. 3684-3690. https://doi.org/10.1210/jc.2012-2269
De Bellis, Annamaria ; Sinisi, A. A. ; Pane, E. ; Dello Iacovo, A. ; Bellastella, G. ; Di Scala, G. ; Falorni, A. ; Giavoli, C. ; Gasco, V. ; Giordano, R. ; Ambrosio, M. R. ; Colao, A. ; Bizzarro, A. ; Bellastella, A. / Involvement of hypothalamus autoimmunity in patients with autoimmune hypopituitarism : Role of antibodies to hypothalamic cells. In: Journal of Clinical Endocrinology and Metabolism. 2012 ; Vol. 97, No. 10. pp. 3684-3690.
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AU - Dello Iacovo, A.

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AU - Falorni, A.

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