MECHANISMS IN ENDOCRINOLOGY: Autoimmune hypopituitarism: novel mechanistic insights

Takahashi, Yutaka

doi:10.1530/eje-19-1051

Cited by 34 publications

(39 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…SH is caused by a variety of inflammatory, infectious, vascular, and neoplastic conditions or as an adverse effect of various medications. Autoimmune hypophysitis results from autoimmunity-mediated destruction of the pituitary gland and is the commonest form of hypophysitis, including most cases of the PH category as well as the systemic autoimmune diseases of the SH forms [7].…”

Section: Resultsmentioning

confidence: 99%

“…Hypophysitis is relatively rare, accounting for approximately 0.24–0.93% of all pituitary diseases [4, 8] – with its incidence constantly increasing with the widespread use of ICIs – and 0.4% of pituitary surgical cases [9]. PH is the commonest form of autoimmune hypophysitis [7]. PH has an incidence of 1/9 million/year and is classified according to etiology, anatomical location, and histopathology [4, 9].…”

Section: Resultsmentioning

confidence: 99%

“…LH is an immune-mediated inflammatory disorder characterized by diffuse infiltration of the pituitary by lymphocytes and variable degrees of fibrosis [7] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Hypophysitis (Including IgG4 and Immunotherapy)

et al. 2020

View full text Add to dashboard Cite

Hypophysitis is characterized by inflammation of the pituitary gland that can be primary (PH) or secondary (SH) to other diseases or following drug administration. It may also be classified according to anatomical and histopathological criteria, leading to variable degrees of hypopituitarism and/or compressive symptoms to nearby structures. There has recently been an increase in the number of hypophysitis cases, raising the interest on the spectrum of its pathogenesis, clinical, biochemical/endocrinological, and imaging features. However, the use of conventional biomarkers, including currently utilized pituitary autoantibodies, has relatively limited diagnostic accuracy. Lymphocytic hypophysitis (LH) is the commonest cause of PH, whereas IgG4-related hypophysitis is increasingly being recognized. Histiocytosis and granulomatous diseases are the most frequent causes of SH, although infections and lymphoma have also been reported. The increasing use of immune checkpoint inhibitors in oncology is associated with a high incidence of hypophysitis, providing further understanding of its pathogenesis. Hy-pophysitis can occur silently and be easily missed, potentially leading to substantial morbidity or mortality due to adrenal insufficiency, requiring a high index of clinical suspicion and timely initiation of appropriate treatment. In most cases of LH or drug-induced hypophysitis, active surveillance along with replacement of established hormonal deficiencies is needed. In the presence of compressive and/or evolving symptoms, treatment with glucocorticoids either alone or in combination with other immunosuppressive agents can be used. Surgical decompression is reserved for nonresponsive cases with threatened vital structures. Timely diagnosis and intervention are important to minimize disease-related morbidity and mortality. We aimed to review current concepts and recent developments in the pathogenesis, diagnosis, and management of hypophysitis.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Hypophysitis (Including IgG4 and Immunotherapy)

et al. 2020

View full text Add to dashboard Cite

show abstract

“…De Bellis et al demonstrated higher pituitary and hypothalamic antibody titers, respectively, in 14.8 and 18.5% of patients with isolated corticotrope deficiency [ 19 ]. Among corticotrope cell antibodies, Tpit antibodies are involved in the development of lymphocytic hypophysitis [ 20 ]. Tpit is an essential transcription factor for the development of corticotrope cells.…”

Section: Discussionmentioning

confidence: 99%

Late-Onset Isolated Corticotrope Deficiency in a Woman with Down Syndrome

Oueslati

Jemaa

Yazidi

et al. 2021

Case Reports in Endocrinology

View full text Add to dashboard Cite

Isolated corticotrope deficiency is a rare cause of secondary adrenocortical insufficiency. Its occurrence in patients with Down syndrome is exceptional. Herein, we report a case of an isolated corticotrope deficiency diagnosed at the age of 33 years in a woman with Down syndrome and discuss its possible mechanisms. A 33-year-old woman with Down syndrome was referred to our department for the investigation of low blood pressure. She complained of asthenia, dizziness, and palpitation with arterial hypotension for the past 4 years. The thyroid function was normal and anti-thyroperoxidase antibodies were negative. The peak of cortisol level in response to the insulin-induced hypoglycemia test was 9.4 μg/dl. ACTH level was normal, indicating corticotrope deficiency. Other pituitary hormones were normal. Magnetic resonance imaging scan revealed a partially empty sella turcica. Genetic analysis showed no mutations and no copy number variants of the TBX19 and NFKB2 genes. The mechanism of isolated corticotrope deficiency is unclear, but it may be induced by autoimmune mechanism in similar to other disorders of patients with Down syndrome.

show abstract

“…[17]. Наибольший интерес представляет аутоиммунная форма заболевания, к которой относятся лимфоцитарный, IgG4-ассоциирован ный [18].…”

Section: эндокринологияunclassified

Secondary Adrenal Insufficiency: New Aspects of Diagnosis and Therapy

Nuralieva¹,

Yukina²,

Трошина³

et al. 2021

View full text Add to dashboard Cite

Objective of the Review: To discuss the current idea of the aetiology, diagnosis and management of secondary adrenal insufficiency (SAI). Key Points. The article describes key causes of the disease, including iatrogenic causes, discusses the widely studied effect of adrenocorticotropic hormone suppression by glucocorticoids and a lesser studied autoimmune hypophysitis induced by check point inhibitors. Special aspects of SAI diagnosis, principles of replacement therapy and cases of unjustified glucocorticoids prescription are given in detail. Risk classification for disease development if glucocorticoids are prescribed for other conditions is presented; an algorithm for management of this group of patients is described. Conclusion. If diagnosed untimely and treated incorrectly, SAI is a severe condition with a high risk of addisonian crisis and death. As the diagnosis is very often challenging, due vigilance is warranted, especially in high-risk groups (patients on long-lasting glucocorticoid therapy). At the same time, unjustified treatment should be avoided if diagnosis is not verified. Keywords: secondary adrenal insufficiency, secondary hypoadrenocorticism, aetiological diagnostics, glucocorticoid therapy.

show abstract

MECHANISMS IN ENDOCRINOLOGY: Autoimmune hypopituitarism: novel mechanistic insights

Cited by 34 publications

References 61 publications

Hypophysitis (Including IgG4 and Immunotherapy)

Hypophysitis (Including IgG4 and Immunotherapy)

Late-Onset Isolated Corticotrope Deficiency in a Woman with Down Syndrome

Secondary Adrenal Insufficiency: New Aspects of Diagnosis and Therapy

Contact Info

Product

Resources

About