RESUMO
La hipofisitis linfocitaria (HL) es un proceso autoinmune caracterizado por infiltración linfocitaria difusa de la glándula pituitaria con grados variables de destrucción. Los niveles elevados de prolactina y la caída de los estrógenos en el posparto son factores predisponentes para su desarrollo por lo que esta patología se presenta principalmente en mujeres jóvenes durante el embarazo o el puerperio. Se desconoce el antígeno implicado en su patogenia. En los últimos años se ha investigado la existencia de anticuerpos antipituitarios (APA) que permitan realizar un diagnóstico certero, de manera sencilla, con una sensibilidad y especificidad aceptables, que faciliten una adecuada interpretación clínica y un tratamiento acorde. Los autores declaran no poseer conflictos de interés.
Lymphocytic hypophysitis (HL) is an autoimmune condition characterized by diffuse lymphocytic infiltration of the pituitary gland with varying degrees of destruction. It occurs mainly in young women during pregnancy or the postpartum period secondary to elevated levels of prolactin (PRL) associated with a drop in estrogen levels in the postpartum period. The antigen involved in its pathogenesis is still unknown. In recent years, the existence of antipituitary antibodies (APA) has been investigated to allow a simple, accurate diagnosis, with acceptable sensitivity and specificity that enables an adequate clinical interpretation and treatment.
RESUMO
Objective To investigate the relationship between antipituitary antibodies (APAs) and hypopituiarism following traumatic brain injury (TBI),as well as the severity of brain injury.Methods The study included 73 patients who suffered TBI 9 to 12 months ago and were diagnosed with hypopituitarism during the follow-up.Based on their Glasgow Coma Scale (GCS) on admission they were categorized into three groups:A (3-8),B (9-12) and C (13-15).Levels of plasma pituitary hormones (GH,TT,FT3 and FSH/LH) and APAs were measured in all patients with chemiluminescence assays and ELISA,respectively.Results Patients in group A had higher levels of APAs and lower levels of hormones compared with those in group B(P＜0.001) or group C(P＜0.001),while no significant difference was found between group B and group C for levels of either APAs (P＞0.05) or hormones (P＞0.05).Levels of APAs were negatively correlated with both GH (r=-0.64071,P＜0.001) and GCS (r=-0.50132,P＜0.001).Conclusion The present investigation provides preliminary evidence that APAs may be associated with the development of TBI-induced hypopituiarism.It suggests that the severity of hypopituiarism following TBI could be predicted by measuring the level of APAs.
RESUMO
Despite autoimmune hypophysitis remains relatively rare, it still poses a significant problem.Currently, about a half of the hypophysitis patients are misdiagnosed as pituitary adenoma and undergo unnecessary surgery. It is increasingly being recognized the identification of the real pituitary autoantigens and development of serologic tests in the differential diagnosis of pituitary masses before surgery. It is necessary to establish disease registration for patients with autoimmnune hypophysitis and get enough well-characterized cases for both basic and clinical studies fostering innovation in the field.