Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Pituitary. 2019 Jun;22(3):236-248. doi: 10.1007/s11102-019-00953-z.
Traumatic brain injury (TBI) is one of the most common causes of mortality and long-term disability and it is associated with an increased prevalence of neuroendocrine dysfunctions. Post-traumatic hypopituitarism (PTHP) results in major physical, psychological and social consequences leading to impaired quality of life. PTHP can occur at any time after traumatic event, evolving through various ways and degrees of deficit, requiring appropriate screening for early detection and treatment. Although the PTHP pathophysiology remains to be elucitated, on the basis of proposed hypotheses it seems to be the result of combined pathological processes, with a possible role played by hypothalamic-pituitary autoimmunity (HPA). This review is aimed at focusing on this possible role in the development of PTHP and its potential clinical consequences, on the basis of the data so far appeared in the literature and of some results of personal studies on this issue.
Scrutinizing the data so far appeared in literature on this topic, we have found only few studies evaluating the autoimmune pattern in affected patients, searching in particular for antipituitary and antihypothalamus autoantibodies (APA and AHA, respectively) by simple indirect immunofluorescence.
The presence of APA and/or AHA at high titers was associated with an increased risk of onset/persistence of PTHP.
HPA seems to contribute to TBI-induced pituitary damage and related PTHP. However, further prospective studies in a larger cohort of patients are needed to define etiopathogenic and diagnostic role of APA/AHA in development of post-traumatic hypothalamic/pituitary dysfunctions after a TBI.
创伤性脑损伤（TBI）是导致死亡和长期残疾的最常见原因之一，并且与神经内分泌功能障碍的患病率增加有关。创伤后垂体功能减退症（PTHP）导致重大的身体、心理和社会后果，导致生活质量受损。PTHP 可在创伤后任何时间发生，通过各种方式和程度的缺陷演变，需要适当的筛查以早期发现和治疗。尽管 PTHP 的病理生理学仍有待阐明，但根据提出的假说，它似乎是多种病理过程共同作用的结果，下丘脑-垂体自身免疫（HPA）可能发挥作用。这篇综述旨在根据迄今为止在文献中出现的数据以及我们在这一问题上的一些研究结果，关注 HPA 在 PTHP 发展中的可能作用及其潜在的临床后果。
仔细研究了迄今为止在这一主题的文献中出现的数据，我们发现只有少数研究评估了受影响患者的自身免疫模式，特别通过简单的间接免疫荧光法寻找抗垂体和抗下丘脑自身抗体（APA 和 AHA）。
高滴度的 APA 和/或 AHA 的存在与 PTHP 发病/持续风险增加相关。
HPA 似乎导致 TBI 引起的垂体损伤和相关的 PTHP。然而，需要对更大的 TBI 后创伤性下丘脑/垂体功能障碍患者队列进行进一步的前瞻性研究，以确定 APA/AHA 在创伤后发展中的病因和诊断作用。
