Mori A, Kajita K, Yamakita N, Morita H, Murai T, Yasuda K, Sugiura M, Miura K
Third Department of Internal Medicine, Gifu University School of Medicine.
Nihon Naibunpi Gakkai Zasshi. 1991 Oct 20;67(10):1147-61. doi: 10.1507/endocrine1927.67.10_1147.
Recently several types of anti-pituitary-antibodies (APA) have been found in patients with pituitary disorders including hypopituitarism and diabetes insipidus, and in postpartum women. However, the pathophysiological role(s) of APA still remains unknown. In order to elucidate the clinical significance of APA, longitudinal follow-up and family study of APA in patients with hypopituitarism were performed. APA in serum was examined in a total of 11 patients with various types of hypopituitarism (7 of isolated ACTH deficiency, 1 of partial hypopituitarism, 3 of Sheehan's syndrome, 6 males and 5 females). Chronic thyroiditis was associated in 3 out of 7 patients with isolated ACTH deficiency, and empty sella was found in each one patient with isolated ACTH deficiency and partial hypopituitarism, and in 3 patients with Sheehan's syndrome. APA was examined on 2 or 3 occasions at more than a 6 month interval (longitudinal study). In 5 patients, their 16 family members were examined for the presence of APA, and pituitary functions were evaluated in 3 out of 7 family members with positive APA (family study). For pituitary function tests, arginine infusion test, TRH, LH-RH or CRH test and insulin tolerance test were performed. APA reacting to rat pituitary cytoplasmic antigens (pituitary cell antibodies: PCA) and APA reacting to rat GH3 cells and/or mouse AtT20 cells surface antigens (pituitary cell surface antibodies: PCSA) were assayed with indirect immunofluorescence method. At the initial examination, 6 out of 11 patients (55%) showed positive APA. The patients were divided into 3 subgroups according to the longitudinal study: the group with disappearance of initially positive APA (3 patients), the group with altered titers or types of initially positive APA (3 patients), and the group with sustained initially negative APA (4 patients). No effects of replacement therapy on the alterations of APA were observed. In 16 family members of 5 patients (each 1 with partial hypopituitarism and isolated ACTH deficiency syndrome, and 3 with Sheehan's syndrome), APA in their sera were investigated. Seven out of 16 members (44%) showed positive APA. Among 6 first-degree relatives of 16 family members, both or either one of APA and PCSA were positive in 4 (67%). Out of 10 of their second- or third-degree relatives, 3 (30%) were positive for PCA or PCSA. All of 3 relatives with positive APA studied showed mild pituitary hypofunction without any clinical manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)
最近，在患有垂体疾病（包括垂体功能减退和尿崩症）的患者以及产后女性中发现了几种类型的抗垂体抗体（APA）。然而，APA的病理生理作用仍然未知。为了阐明APA的临床意义，对垂体功能减退患者进行了APA的纵向随访和家族研究。共检测了11例各种类型垂体功能减退患者的血清APA（7例孤立性促肾上腺皮质激素缺乏，1例部分垂体功能减退，3例席汉综合征，6例男性和5例女性）。7例孤立性促肾上腺皮质激素缺乏患者中有3例合并慢性甲状腺炎，孤立性促肾上腺皮质激素缺乏和部分垂体功能减退的患者各有1例发现空蝶鞍，3例席汉综合征患者也发现空蝶鞍。每隔6个月以上对患者进行2至3次APA检测（纵向研究）。对5例患者的16名家庭成员检测了APA的存在情况，对7名APA阳性的家庭成员中的3名评估了垂体功能（家族研究）。进行垂体功能测试时，采用了精氨酸输注试验、促甲状腺激素释放激素（TRH）、促黄体生成素释放激素（LH-RH）或促肾上腺皮质激素释放激素（CRH）试验以及胰岛素耐量试验。采用间接免疫荧光法检测对大鼠垂体细胞质抗原起反应的APA（垂体细胞抗体：PCA）和对大鼠GH3细胞和/或小鼠AtT20细胞表面抗原起反应的APA（垂体细胞表面抗体：PCSA）。在初次检查时，11例患者中有6例（55%）APA呈阳性。根据纵向研究将患者分为3个亚组：最初阳性的APA消失的组（3例患者）、最初阳性的APA滴度或类型改变的组（3例患者）以及最初持续阴性的APA组（4例患者）。未观察到替代疗法对APA改变有影响。对5例患者的16名家庭成员（1例部分垂体功能减退和孤立性促肾上腺皮质激素缺乏综合征患者，3例席汉综合征患者）检测了他们血清中的APA。16名成员中有7名（44%）APA呈阳性。在16名家庭成员的6名一级亲属中，4名（67%）的PCA和PCSA两者或其中之一呈阳性。在他们的10名二级或三级亲属中，3名（30%）的PCA或PCSA呈阳性。所有3名研究的APA阳性亲属均表现为轻度垂体功能减退，无任何临床表现。（摘要截选至400字）
