De Bellis Annamaria, Bellastella Giuseppe, Colella Caterina, Bizzarro Antonio, Bellastella Antonio, Esposito Katherine
a Chair of Endocrinology and Metabolism, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.
c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy.
Expert Rev Endocrinol Metab. 2014 Sep;9(5):465-476. doi: 10.1586/17446651.2014.932689. Epub 2014 Jun 26.
Lymphocytic hypophysitis is characterized by an extensive infiltration of lymphocytic cells. Pituitary biopsy is the gold diagnostic standard for lymphocytic hypophysitis but the disease occurs with moderate or without pituitary enlargement. The role of antipituitary antibodies (APA) in autoimmune hypophysitis is still discussed due to various methodological difficulties. Indirect immunofluorescence, a widely employed method to detect APA at this time produces highly variable results due to the use of human or animal pituitary substrates. For many years the authors have conducted a re-evaluation of APA by immunofluorescence in patients with other autoimmune diseases and in patients with apparently idiopathic hypopituitarism, using pituitary from young baboons as substrate but considering a predetermined cut-off of the titer and immunofluorescence pattern. This procedure allowed us to find out those with autoimmune pituitary impairment and to foresee the kind of future hypopituitarism in those with pituitary function still normal. Moreover, in APA positive patients, the use of a second step of a double immunofluorescence method allowed identification of the pituitary cells targeted by APA, verifying the correspondence with the kind of hypopituitarism, also when present in subclinical stage. However, to carry out an international workshop comparing the detection of APA by immunofluorescence using different substrates could contribute to verify the best choice to improve the sensitivity and specificity of this method.
淋巴细胞性垂体炎的特征是淋巴细胞广泛浸润。垂体活检是淋巴细胞性垂体炎的金标准诊断方法，但该疾病发生时垂体肿大程度中等或无肿大。由于各种方法学上的困难，抗垂体抗体（APA）在自身免疫性垂体炎中的作用仍在讨论中。间接免疫荧光法是目前广泛用于检测APA的方法，由于使用人或动物垂体底物，其结果差异很大。多年来，作者使用幼年狒狒的垂体作为底物，通过免疫荧光法对其他自身免疫性疾病患者和明显特发性垂体功能减退患者的APA进行了重新评估，但考虑了预先确定的滴度和免疫荧光模式的临界值。这一程序使我们能够找出那些有自身免疫性垂体损害的患者，并预测那些垂体功能仍正常的患者未来垂体功能减退的类型。此外，在APA阳性患者中，使用双免疫荧光法的第二步可以识别APA靶向的垂体细胞，验证与垂体功能减退类型的对应关系，即使在亚临床阶段也是如此。然而，举办一次国际研讨会，比较使用不同底物通过免疫荧光法检测APA的情况，可能有助于验证提高该方法敏感性和特异性的最佳选择。
