Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
Pituitary. 2016 Dec;19(6):625-642. doi: 10.1007/s11102-016-0736-z.
This publication reviews the accepted knowledges and the findings still discussed on several features of autoimmune hypophysitis, including the most recently described forms, such as IgG4 and cancer immunotherapy- related hypophysitis.
The most characteristic findings and the pending controversies were derived from a literature review and previous personal experiences. A single paragraph focused on some atypical examples of the disease presenting under confounding pretences.
Headache, visual field alterations and impaired pituitary secretion are the most frequent clinical findings of the disease. Pituitary biopsy, still considered the gold diagnostic standard, does not always receive consent from the patients. The role of magnetic resonance imaging is limited, as this disease may generate images similar to those of other diseases. The role of antipituitary and antihypothalamus antibodies is still discussed owing to methodological difficulties and also because the findings on the true pituitary antigen(s) are still debated. However, the low sensitivity and specificity of immunofluorescence, one of the more widely employed methods to detect these antibodies, may be improved, considering a predetermined cut-off titre and a particular kind of immunostaining.
Autoimmune hypophysitis is a multifaceted disease, which may certainly be diagnosed by pituitary biopsy. However, the possible different clinical, laboratory and imaging features must be considered by the physician to avoid a misdiagnosis when examining a possibly affected patient. Therapeutic choice has to be made taking into account the clinical conditions and the degree of hypothalamic-pituitary involvement, but also considering that spontaneous remissions can occur.
本出版物回顾了自身免疫性垂体炎的几个特征的公认知识和仍在讨论的发现，包括最近描述的形式，如 IgG4 和癌症免疫治疗相关的垂体炎。
最具特征性的发现和悬而未决的争议来自文献回顾和以前的个人经验。有一段专门讨论了一些以混淆为借口表现出的疾病的非典型例子。
头痛、视野改变和垂体分泌功能障碍是该疾病最常见的临床发现。垂体活检，尽管仍被认为是黄金诊断标准，但并不总是能得到患者的同意。磁共振成像的作用有限，因为这种疾病可能产生与其他疾病相似的图像。抗垂体和抗下丘脑抗体的作用仍在讨论中，这归因于方法学上的困难，也归因于对真正的垂体抗原的发现仍有争议。然而，免疫荧光检测这些抗体的一种更广泛应用的方法，由于敏感性和特异性低，其检测结果可能会有所改善，可考虑预设的临界滴度和特定的免疫染色。
自身免疫性垂体炎是一种多方面的疾病，通过垂体活检肯定可以诊断。然而，在检查可能受影响的患者时，医生必须考虑到可能不同的临床、实验室和影像学特征，以避免误诊。治疗选择必须考虑到临床情况和下丘脑-垂体受累的程度，但也要考虑到可能会发生自发缓解。
