Immunofluorescence studies on autoantibodies to steroid-producing cells, and to germline cells in endocrine disease and infertility.

This study was aimed at comparing the clinical significance of antibodies to steroid-producing cells with reactions to gonadal germline cells in patients with autoimmune polyendocrine diseases and isolated infertility or amenorrhoea respectively. Indirect immunofluorescence was used on human adrenal, ovary and testis. The gonad substrates were compared with rat, rabbit and monkey glands. 152 adrenal-positive sera were selected from 1030 that had been tested on adrenal cortex. Antibodies to steroid-producing cells in the gonads were found in fifty of these 152 selected cases and were studied in detail. When using human gonads as substrates, steroid-producing-cell antibodies were never detected in the absence of adrenal cortical immunofluorescence, though false-positive reactions were sometimes obtained on rat or rabbit gonads. Adrenal antibodies as well as those to steroid-producing cells were most frequent in Addisonian cases having one or more additional endocrine disease. The frequency of both types of antibody was lower in patients with Addison's disease and no other disorder but showing evidence of polyendocrine serology'. Both antibodies were found least frequently when adrenalitis was unassociated with clinical or subclinical autoimmunity in other organs. We were able to confirm the immunofluorescence patterns described by other authors on adrenal gland and gonads, as well as the independent rise or fall in titre of these two types of antibodies in individual cases with time. Prolonged follow-up of forty-two Addisonian patients showed that adrenal antibodies disappeared in seven instances (17%). Ovum and sperm antibodies were found in about 25% of infertility cases and a smaller proportion of polyendocrine patients. Germline cell antibodies were rarely associated with other organ-specific reactions. In two cases, amenorrhoea was due to partial pituitary deficiency and the sera of the patients contained antibodies to pituitary prolactin-cells. Testicular basement membrane' or `Sertoli-cell' immunofluorescence were each observed in isolated cases and are discussed in relation to known non-organ-specific and heterophile patterns. The significance of zona pellucida fluorescence in relation to blood group substances requires further study on human ova obtained by aspiration from mature Graafian follicles.