ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Indirect immunofluorescence for detection of pituitary antibodies
Nuno Vicente 1 , Monica Taylor 2 , Luísa Barros 1 , Leonor Gomes 1 , Dírcea Rodrigues 1 , Sandra Paiva 1 , Isabel Paiva 1 , Daniela Guelho 1 , Luís Cardoso 1 , Diana Martins 1 , Diana Oliveira 1 , Patrizio Caturegli 2 & Francisco Carrilho 1
1Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário Coimbra, EPE, Coimbra, Portugal; 2Department of Pathology, School of Medicine, The John Hopkins University, Baltimore, Maryland, USA.
Introduction: Definitive diagnosis of lymphocytic hypophisitis (LH) lacks a pathological analysis. The detection of pituitary antibodies (PAB) with the current methods presents variable results and its clinical utility is therefore limited. Recently, new methods were released for the interpretation of indirect immunofluorescence (IIF), which can increase the specificity for detection of PAB.
Methods: We evaluated four patients followed in endocrinology consultation with clinical suspicion of LH (patient 1: 49 years old female with pan-hypopituitarism beginning 40 days after delivery and an empty sella on MRI; patient 2: 20 years old male with isolated ACTH deficiency and gynecomastia; patient 3: 59 years old female with previous complaints of severe headache and dyplopia starting at 42 years, MRI showing pituitary enlargement with diffuse enhancement after contrast and pan-hypopituitarism ever since; patient 4: 39 years old male with hypogonadotrophic hypogonadism and autoimmune thyroiditis) and one patient with definitive diagnosis of LH; and patient 5: 27 years old female, with severe headaches beginning 1 week before delivery, MRI compatible with a pituitary macroadenoma with diffuse enhancement after contrast. Detection of PAB by IIF was carried out in a specialised centre. The presence of PAB was considered positive whenever a granular of diffuse cytosolic pattern were present, after using purified IgG and Fc blockade, if necessary.
Results: We obtained positive results in 40% of samples (two out of five). Patient 1: negative; patient 2: mild perinuclear positivity (1+); patient 3: negative; patient 4: cytosolic positivity, granular pattern; and patient 5: cytosolic positivity, diffuse pattern.
Discussion and conclusions: The patient with histological diagnosis of LH exhibits a diffuse cytosolic pattern, as usually happens in pituitary disease of autoimmune etiology. The granular cytosolic pattern of patient 4, which is strongly suggestive of autoimmunity, might establish diagnosis of LH. Detection of PAB by IFI, according to the immunostaining patterns, can help in the classification and management of these patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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