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Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan's syndrome

Chair of Endocrinology, Department of Clinical and Experimental Medicine and Surgery ‘F. Magrassi, A. Lanzara’, Second University of Naples, via Pansini N. 5, 80131 Napoli, Italy¹ Department of Endocrinology and Metabolism, Erciyes University Medical School, Kayseri, Turkey² Chair of Surgery and³ Chair of Immunology, Department of Clinical and Experimental Medicine and Surgery ‘F. Magrassi, A. Lanzara’, Second University of Naples, Naples, Italy

(Correspondence should be addressed to A De Bellis; Email: annamaria.debellis{at}unina2.it)

Objective: While anti-pituitary antibodies (APAs) were detected in some patients with Sheehan's syndrome (SS) suggesting an autoimmune pituitary involvement in the development of their hypopituitarism, hypothalamic cell anti-hypothalamus antibodies (AHAs) have not been investigated so far.

Design: The aim of this study was to evaluate the presence of AHA and APA in SS patients to verify whether an autoimmune hypothalamic–pituitary process can contribute to their late hypopituitarism.

Methods: Twenty women with SS with a duration of disease ranging from 3 to 40 years (median 25.5 years) were enrolled into the study. Out of 20 patients, 12 (60%) had panhypopituitarism and the others had partial hypopituitarism well corrected with appropriate replacement therapy. None of them had clinical central diabetes insipidus. AHA and APA were investigated by immunofluorescence method in all patients. In addition, a four-layer immunofluorescence method was used to verify whether AHA immunostained vasopressin-secreting cells (AVP-c) or not.

Results: AHAs were found in 8 out of 20 (40%) and APAs in 7 out of 20 (35%) patients with titers ranging from 1:32 to 1:128 and 1:16 to 1:32 respectively; however, in none of these positive patients AHA immunostained vasopressin cells. None of controls resulted positive for both antibodies.

Conclusions: Patients with SS, even many years after the onset of SS, can show antibodies to pituitary and/or hypothalamic but not AVP-secreting cells. Antibodies to unknown hypothalamic cells (releasing factor-secreting cells) other than APAs suggest that an autoimmune process involving both the hypothalamus and pituitary gland may contribute to late pituitary dysfunction in SS patients.