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

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, M. R. Ambrosio, E. Arvat, P. Beck-Peccoz, C. Betterle, S. Cannavò, E. Degli Uberti, R. Giordano, E. GhigoG. Lombardi, M. Maghnie, F. Mantero, L. Persani, A. Spada, F. Santeusanio, M. Delvecchio

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)3750-3757
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume95
Issue number8
DOIs
Publication statusPublished - Aug 2010

ASJC Scopus subject areas

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

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