Longitudinal Study of Patients with Idiopathic Isolated TSH Deficiency: Possible Progression of Pituitary Dysfunction in Lymphocytic Adenohypophysitis

Hashimoto, Kazuhito; Yamakita, Noriyoshi; Ikeda, Tsuneko; Matsuhisa, Takashi; Kuwayama, Akio; Sendo, Toshiaki; Hashimoto, Kozo

doi:10.1507/endocrj.k06-055

Cited by 17 publications

(13 citation statements)

References 38 publications

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“…It is often associated with a hypofunctional disorder of 1 or more hormones due to insufficient residual anterior pituitary parenchyma. Therefore, most publications that link hypothyroidism with ES refer to secondary hypothyroidism (with reduced TSH) that can be associated or not with other secondary hormone deficiencies [16][17][18]. Reports of primary hypothyroidism are sporadic.…”

Section: Discussionmentioning

confidence: 99%

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Empty sella and primary autoimmune hypothyroidism

et al. 2009

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In order to assess the association between empty sella (ES) and primary autoimmune hypothyroidism, and the possibility of a common pathogenesis. We retrospectively studied all patients with presumed ES diagnosed in the last 20 years, most of whom were treated by our Endocrinology Department. Subjects with a known etiology were excluded. Incomplete records or those with a doubtful diagnosis were also excluded. A total of 56 subjects were included in the study. ES was diagnosed by pituitary MRI. The measurement of free T4, TSH, and antithyroid antibodies (TPOAb and TgAb) was assayed using commercial kits. The cases of hypothyroidism obtained were compared with those in another group of similar patients, diagnosed with diabetes mellitus type 2, through chi2 test. A total of 15 (26.78%) patients of 56 with ES had autoimmune thyroid disease (subclinical or clinical hypothyroidism). Primary hypothyroidism with negative antithyroid autoantibodies was found in a further 13 patients (23.21%). The 46.42% of ES had primary hypothyroidism; this result had obtained a statistically significant difference when compared to the ratio obtained in the group of diabetes mellitus type 2 (P < 0.0029). There is an important association between ES and autoimmune thyroid disease, which reached 26.78% in our series. We suggest the possibility of a common pathogenesis for certain cases of ES and autoimmune thyroid disease, with the end point of ES in the pituitary, and atrophy in the thyroid gland.

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Section: Discussionmentioning

confidence: 99%

“…In some cases, it is possible to document the progression of hypophysitis to ES [9] or to make an association between them [18]. One of the most characteristic cases was that reported by Matta et al [48] involving a 45-yearold woman with biopsy-confirmed lymphocytic hypophysitis and autoimmune thyroiditis.…”

Section: Discussionmentioning

confidence: 99%

Empty sella and primary autoimmune hypothyroidism

et al. 2009

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“…Isolated thyrotropin deficiency of autoimmune origin was first reported by Wong in 2004 in a biopsy proven case of lymphocytic hypophysitis, and then by Hashimoto in a case series of 6 patients (one of whom was histologically proven) [40]. Pituitary antibodies against candidate pituitary antigens have been measured by Amino's group in four additional patients, and found to be absent or low (Table 1).…”

Section: Pituitary Antibodies In Isolated Pituitary Hormone Deficienciesmentioning

confidence: 93%

Pituitary autoimmunity: 30 years later

Caturegli

Lupi

Landek-Salgado

et al. 2008

Autoimmunity Reviews

160

147

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Pituitary autoimmunity encompasses a spectrum of conditions ranging from histologically proven forms of lymphocytic hypophysitis to the presence of pituitary antibodies in apparently healthy subjects. Hypophysitis is a rare but increasingly recognized disorder that typically presents as a mass in the sella turcica. It mimics clinically and radiologically other non-secreting sellar masses, such as the more common pituitary adenoma. Hypophysitis shows a striking temporal association with pregnancy, and it has been recently described during immunotherapies that block CTLA-4. Several candidate pituitary autoantigens have been described in the last decade, although none has proven useful as a diagnostic tool. This review summarizes the advances made in the field since the publication of the first review on pituitary autoimmunity, and the challenges that await clarification.

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“…1 This antibody reacts positively in 15%, 20%, and 26% of patients with isolated adrenocorticotropic hormone (ACTH), growth hormone, and gonadotropin deficiency, respectively, and in a few patients with isolated thyrotropin deficiency. 17 Because APA has been detected in several other diseases such as type 1 diabetes mellitus, Hashimoto thyroiditis, Graves disease, and pituitary adenomas, its specificity is poor. Thus, APA is not adequately useful as a diagnostic tool for hypophysitis.…”

Section: Risk Factorsmentioning

confidence: 99%