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Pituitary
Published in: Pituitary 6/2016

01-12-2016

Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects

Authors: Giuseppe Bellastella, Maria Ida Maiorino, Antonio Bizzarro, Dario Giugliano, Katherine Esposito, Antonio Bellastella, Annamaria De Bellis

Published in: Pituitary | Issue 6/2016

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Abstract

Purpose

This publication reviews the accepted knowledges and the findings still discussed on several features of autoimmune hypophysitis, including the most recently described forms, such as IgG4 and cancer immunotherapy- related hypophysitis.

Methods

The most characteristic findings and the pending controversies were derived from a literature review and previous personal experiences. A single paragraph focused on some atypical examples of the disease presenting under confounding pretences.

Results

Headache, visual field alterations and impaired pituitary secretion are the most frequent clinical findings of the disease. Pituitary biopsy, still considered the gold diagnostic standard, does not always receive consent from the patients. The role of magnetic resonance imaging is limited, as this disease may generate images similar to those of other diseases. The role of antipituitary and antihypothalamus antibodies is still discussed owing to methodological difficulties and also because the findings on the true pituitary antigen(s) are still debated. However, the low sensitivity and specificity of immunofluorescence, one of the more widely employed methods to detect these antibodies, may be improved, considering a predetermined cut-off titre and a particular kind of immunostaining.

Conclusion

Autoimmune hypophysitis is a multifaceted disease, which may certainly be diagnosed by pituitary biopsy. However, the possible different clinical, laboratory and imaging features must be considered by the physician to avoid a misdiagnosis when examining a possibly affected patient. Therapeutic choice has to be made taking into account the clinical conditions and the degree of hypothalamic-pituitary involvement, but also considering that spontaneous remissions can occur.
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Metadata
Title
Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects
Authors
Giuseppe Bellastella
Maria Ida Maiorino
Antonio Bizzarro
Dario Giugliano
Katherine Esposito
Antonio Bellastella
Annamaria De Bellis
Publication date
01-12-2016
Publisher
Springer US
Published in
Pituitary / Issue 6/2016
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-016-0736-z

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