1
|
Han TS, Antonio L, Bartfai G, O'Neill TW, Punab M, Rastrelli G, Maggi M, Słowikowska-Hilczer J, Tournoy J, Vanderschueren D, Lean MEJ, Huhtaniemi IT, Wu FCW, Castro AI, Carreira MC, Casanueva FF. Evidence-based definition of hypoprolactinemia in European men aged 40-86 years: the European male ageing study. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09890-0. [PMID: 38829475 DOI: 10.1007/s11154-024-09890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
Empirical evidence for a low normal or reference interval for serum prolactin (PRL) is lacking for men, while the implications of very low PRL levels for human health have never been studied. A clinical state of "PRL deficiency" has not been defined except in relation to lactation. Using data from the European Male Ageing Study (EMAS), we analyzed the distribution of PRL in 3,369 community-dwelling European men, aged 40-80 years at phase-1 and free from acute illnesses. In total, 2,948 and 2,644 PRL samples were collected during phase-1 and phase-2 (3 to 5.7 years later). All samples were analysed in the same centre with the same assay. After excluding individuals with known pituitary diseases, PRL ≥ 35 ng/ml, and PRL-altering drugs including antipsychotic agents, selective serotonin reuptake inhibitors, or dopamine agonists, 5,086 data points (2,845 in phase-1 and 2,241 in phase-2) were available for analysis. The results showed that PRL declined minimally with age (slope = -0.02) and did not correlate with BMI. The positively skewed PRL distribution was log-transformed to a symmetrical distribution (skewness reduced from 13.3 to 0.015). Using two-sigma empirical rule (2[]SD about the mean), a threshold at 2.5% of the lower end of the distribution was shown to correspond to a PRL value of 2.98ng/ml. With reference to individuals with PRL levels of 5-34.9 ng/ml (event rate = 6.3%), the adjusted risk of developing type 2 diabetes increased progressively in those with PRL levels of 3-4.9 ng/ml: event rate = 9.3%, OR (95% CI) 1.59 (0.93-2.71), and more so with PRL levels of 0.3-2.9 ng/ml: event rate = 22.7%, OR 5.45 (1.78-16.62). There was also an increasing trend in prediabetes and diabetes based on fasting blood glucose levels was observed with lower categories of PRL. However, PRL levels were not associated with cancer, cardiovascular diseases, depressive symptoms or mortality. Our findings suggest that a PRL level below 3 ng/ml (64 mlU/l) significantly identifies European men with a clinically-important outcome (of type 2 diabetes), offering a lower reference-value for research and clinical practice.
Collapse
Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Leen Antonio
- Department of Clinical and Experimental Medicine, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Manchester Biomedical Research Centre, The University of Manchester & NIHR, Manchester University NHS Foundation Trust, Manchester, UK
| | - Margus Punab
- Andrology Clinic, Tartu University Hospital, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit - Careggi Teaching Hospital, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Jos Tournoy
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Department of Clinical and Experimental Medicine, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Michael E J Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental, Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London, UK
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ana I Castro
- Department of Medicine, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, , Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (IDIS), Santiago de Compostela, CB06/03, Spain
| | - Marcos C Carreira
- Department of Medicine, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, , Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (IDIS), Santiago de Compostela, CB06/03, Spain
| | - Felipe F Casanueva
- Department of Medicine, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, , Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (IDIS), Santiago de Compostela, CB06/03, Spain.
| |
Collapse
|
2
|
Karaca Z, Unluhizarci K, Kelestimur F. Hypoprolactinemia. Does it matter? Redefining the hypopituitarism and return from a mumpsimus : "Absence of proof is not the proof of absence". Rev Endocr Metab Disord 2023:10.1007/s11154-023-09847-9. [PMID: 37875774 DOI: 10.1007/s11154-023-09847-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
Prolactin (PRL) is secreted by the lactotroph cells in the anterior pituitary gland which is under inhibitory control of dopamine. The mature human PRL has more than 300 physiological actions including lactation, reproduction, homeostasis, neuroprotection, behavior, water and electrolyte balance, immunoregulation and embryonic and fetal development. PRL is involved in the growth and development of mammary gland, preparation of the breast for lactation in the postpartum period, synthesis of milk, and maintenance of milk secretion. Abnormalities in the synthesis and secretion of PRL may result in hyperprolactinemia or hypoprolactinemia. Although hyperprolactinemia has been extensively investigated in the literature, because of the subtle or unclearly defined symptoms, hypoprolactinemia is a less-known and neglected disorder. Failure of lactation is a well-known clinical manifestation of hypoprolactinemia. Recent studies reveal that hypoprolactinemia may have some effects beyond lactation such as increased risk for metabolic abnormalities including insulin resistance, abnormal lipid profile, obesity and sexual dysfunction. Very low level of PRL is suggested to be avoided in patients receiving dopamin agonist treatment to prevent unwanted effects of hypoprolactinemia. Another important point is that hypoprolactinemia is not included in the classification of hypopituitarism. Anterior pituitary failure is traditionally classified as isolated, partial and complete (panhypopituitarism) hypopituitarism regardless of prolactin level. Therefore, there are two kinds of panhypopituitarism: panhypopituitarism with normal or high PRL level and panhypopituitarism with low PRL level. In this review, we present two personal cases, discuss the diagnosis of hypoprolactinemia, hypoprolactinemia associated clinical picture and suggest to redefine the classification of hypopituitarism.
Collapse
Affiliation(s)
- Zuleyha Karaca
- Faculty of Medicine, Department of Endocrinology Kayseri, Erciyes University, Talas/Kayseri, Turkey
| | - Kursad Unluhizarci
- Faculty of Medicine, Department of Endocrinology Kayseri, Erciyes University, Talas/Kayseri, Turkey
| | - Fahrettin Kelestimur
- Faculty of Medicine, Department of Endocrinology İstanbul, Yeditepe University, Ataşehir/İstanbul, Turkey.
| |
Collapse
|
3
|
Hannan FM, Elajnaf T, Vandenberg LN, Kennedy SH, Thakker RV. Hormonal regulation of mammary gland development and lactation. Nat Rev Endocrinol 2023; 19:46-61. [PMID: 36192506 DOI: 10.1038/s41574-022-00742-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
Lactation is critical to infant short-term and long-term health and protects mothers from breast cancer, ovarian cancer and type 2 diabetes mellitus. The mammary gland is a dynamic organ, regulated by the coordinated actions of reproductive and metabolic hormones. These hormones promote gland development from puberty onwards and induce the formation of a branched, epithelial, milk-secreting organ by the end of pregnancy. Progesterone withdrawal following placental delivery initiates lactation, which is maintained by increased pituitary secretion of prolactin and oxytocin, and stimulated by infant suckling. After weaning, local cytokine production and decreased prolactin secretion trigger large-scale mammary cell loss, leading to gland involution. Here, we review advances in the molecular endocrinology of mammary gland development and milk synthesis. We discuss the hormonal functions of the mammary gland, including parathyroid hormone-related peptide secretion that stimulates maternal calcium mobilization for milk synthesis. We also consider the hormonal composition of human milk and its associated effects on infant health and development. Finally, we highlight endocrine and metabolic diseases that cause lactation insufficiency, for example, monogenic disorders of prolactin and prolactin receptor mutations, maternal obesity and diabetes mellitus, interventions during labour and delivery, and exposure to endocrine-disrupting chemicals such as polyfluoroalkyl substances in consumer products and other oestrogenic compounds.
Collapse
Affiliation(s)
- Fadil M Hannan
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
| | - Taha Elajnaf
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Stephen H Kennedy
- Larsson-Rosenquist Foundation Oxford Centre for the Endocrinology of Human Lactation, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Prencipe N, Marinelli L, Varaldo E, Cuboni D, Berton AM, Bioletto F, Bona C, Gasco V, Grottoli S. Isolated anterior pituitary dysfunction in adulthood. Front Endocrinol (Lausanne) 2023; 14:1100007. [PMID: 36967769 PMCID: PMC10032221 DOI: 10.3389/fendo.2023.1100007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and prolactin deficiency. Patients with hypopituitarism suffer from an increased disability and sick days, resulting in lower health status, higher cost of care and an increased mortality. In particular during adulthood, isolated pituitary deficits are not an uncommon finding; their clinical picture is represented by vague symptoms and unclear signs, which can be difficult to properly diagnose. This often becomes a challenge for the physician. Aim of this narrative review is to analyse, for each anterior pituitary deficit, the main related etiologies, the characteristic signs and symptoms, how to properly diagnose them (suggesting an easy and reproducible step-based approach), and eventually the treatment. In adulthood, the vast majority of isolated pituitary deficits are due to pituitary tumours, head trauma, pituitary surgery and brain radiotherapy. Immune-related dysfunctions represent a growing cause of isolated pituitary deficiencies, above all secondary to use of oncological drugs such as immune checkpoint inhibitors. The diagnosis of isolated pituitary deficiencies should be based on baseline hormonal assessments and/or dynamic tests. Establishing a proper diagnosis can be quite challenging: in fact, even if the diagnostic methods are becoming increasingly refined, a considerable proportion of isolated pituitary deficits still remains without a certain cause. While isolated ACTH and TSH deficiencies always require a prompt replacement treatment, gonadal replacement therapy requires a benefit-risk evaluation based on the presence of comorbidities, age and gender of the patient; finally, the need of growth hormone replacement therapies is still a matter of debate. On the other side, prolactin replacement therapy is still not available. In conclusion, our purpose is to offer a broad evaluation from causes to therapies of isolated anterior pituitary deficits in adulthood. This review will also include the evaluation of uncommon symptoms and main etiologies, the elements of suspicion of a genetic cause and protocols for diagnosis, follow-up and treatment.
Collapse
|
5
|
Partenope C, Pedranzini Q, Petri A, Rabbone I, Prodam F, Bellone S. AVP deficiency (central diabetes insipidus) following immunization with anti-COVID-19 BNT162b2 Comirnaty vaccine in adolescents: A case report. Front Endocrinol (Lausanne) 2023; 14:1166953. [PMID: 37143723 PMCID: PMC10151784 DOI: 10.3389/fendo.2023.1166953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction The coronavirus disease 19 (COVID-19) pandemic has prompted the development of new vaccines to reduce the morbidity and mortality associated with this disease. Recognition and report of potential adverse effects of these novel vaccines (especially the urgent and life-threatening ones) is therefore essential. Case presentation A 16-year-old boy presented to the Paediatric Emergency Department with polyuria, polydipsia and weight loss over the last four months. His past medical history was unremarkable. Onset of symptoms was referred to be few days after first dose of anti-COVID-19 BNT162b2 Comirnaty vaccine and then worsened after the second dose. The physical exam was normal, without neurological abnormalities. Auxological parameters were within normal limits. Daily fluid balance monitoring confirmed polyuria and polydipsia. Biochemistry laboratory analysis and urine culture were normal. Serum osmolality was 297 mOsm/Kg H2O (285-305), whereas urine osmolality was 80 mOsm/Kg H2O (100-1100), suggesting diabetes insipidus. Anterior pituitary function was preserved. Since parents refused to give consent to water deprivation test, treatment with Desmopressin was administered and confirmed ex juvantibus diagnosis of AVP deficiency (or central diabetes insipidus). Brain MRI revealed pituitary stalk thickening (4 mm) with contrast enhancement, and loss of posterior pituitary bright spot on T1 weighted imaging. Those signs were consistent with neuroinfundibulohypophysitis. Immunoglobulin levels were normal. Low doses of oral Desmopressin were sufficient to control patient's symptoms, normalizing serum and urinary osmolality values and daily fluid balance at discharge. Brain MRI after 2 months showed stable thicken pituitary stalk and still undetectable posterior pituitary. Due to persistence of polyuria and polydipsia, therapy with Desmopressin was adjusted by increasing dosage and number of daily administrations. Clinical and neuroradiological follow-up is still ongoing. Conclusion Hypophysitis is a rare disorder characterized by lymphocytic, granulomatous, plasmacytic, or xanthomatous infiltration of the pituitary gland and stalk. Common manifestations are headache, hypopituitarism, and diabetes insipidus. To date, only time correlation between SARS-CoV-2 infection and development of hypophysitis and subsequent hypopituitarism has been reported. Further studies will be needed to deepen a possible causal link between anti-COVID-19 vaccine and AVP deficiency.
Collapse
Affiliation(s)
- Cristina Partenope
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- *Correspondence: Cristina Partenope,
| | - Quincy Pedranzini
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Antonella Petri
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|
6
|
Abstract
Pituitary autoimmunity is one of the principal causes of hypopituitarism. Additionally, hypophysitis is one of the immune-related adverse events associated with immunotherapy. Recent case-oriented research has revealed a novel type of autoimmune hypophysitis, anti-PIT-1 hypophysitis, related to isolated adrenocorticotropic hormone (ACTH) deficiency and immune checkpoint inhibitor-related hypophysitis, as a form of paraneoplastic syndrome. Under these conditions, the ectopic expression of pituitary antigens present in tumors evokes a breakdown of immune tolerance, resulting in the production of autoantibodies and autoreactive cytotoxic T cells that specifically harm pituitary cells. Consequently, an innovative clinical entity of paraneoplastic autoimmune hypophysitis has been purported. This novel concept and its underlying mechanisms provide clues for understanding the pathogenesis of autoimmune pituitary diseases and can be applied to other autoimmune diseases. This review discusses the etiology of paraneoplastic autoimmune hypophysitis and its future.
Collapse
Affiliation(s)
- Hironori Bando
- Division of Development of Advanced Therapy for Metabolic Diseases, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Keitaro Kanie
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan.
| |
Collapse
|
7
|
Miyake N, Nagai T, Suga H, Osuka S, Kasai T, Sakakibara M, Soen M, Ozaki H, Miwata T, Asano T, Kano M, Muraoka A, Nakanishi N, Nakamura T, Goto M, Yasuda Y, Kawaguchi Y, Miyata T, Kobayashi T, Sugiyama M, Onoue T, Hagiwara D, Iwama S, Iwase A, Inoshita N, Arima H, Kajiyama H. Functional Lactotrophs in Induced Adenohypophysis Differentiated From Human iPS Cells. Endocrinology 2022; 163:6516050. [PMID: 35085394 DOI: 10.1210/endocr/bqac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 11/19/2022]
Abstract
Prolactin (PRL), a hormone involved in lactation, is mainly produced and secreted by the lactotrophs of the anterior pituitary (AP) gland. We previously reported a method to generate functional adrenocorticotropic hormone-producing cells by differentiating the AP and hypothalamus simultaneously from human induced pluripotent stem cells (iPSCs). However, PRL-producing cells in the induced AP have not been investigated. Here, we confirmed the presence of PRL-producing cells and evaluated their endocrine functions. We differentiated pituitary cells from human iPSCs using serum-free floating culture of embryoid-like aggregates with quick reaggregation (SFEB-q) method and evaluated the appearance and function of PRL-producing cells. Secretion of PRL from the differentiated aggregates was confirmed, which increased with further culture. Fluorescence immunostaining and immunoelectron microscopy revealed PRL-producing cells and PRL-positive secretory granules, respectively. PRL secretion was promoted by various prolactin secretagogues such as thyrotropin-releasing hormone, vasoactive intestinal peptide, and prolactin-releasing peptide, and inhibited by bromocriptine. Moreover, the presence of tyrosine hydroxylase-positive dopaminergic nerves in the hypothalamic tissue area around the center of the aggregates connecting to PRL-producing cells indicated the possibility of recapitulating PRL regulatory mechanisms through the hypothalamus. In conclusion, we generated pituitary lactotrophs from human iPSCs; these displayed similar secretory responsiveness as human pituitary cells in vivo. In the future, this is expected to be used as a model of human PRL-producing cells for various studies, such as drug discovery, prediction of side effects, and elucidation of tumorigenic mechanisms using disease-specific iPSCs. Furthermore, it may help to develop regenerative medicine for the pituitary gland.
Collapse
Affiliation(s)
- Natsuki Miyake
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Takashi Nagai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Takatoshi Kasai
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mayu Sakakibara
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mika Soen
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Hajime Ozaki
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Tsutomu Miwata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Tomoyoshi Asano
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mayuko Kano
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Ayako Muraoka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Natsuki Nakanishi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yoshinori Yasuda
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yohei Kawaguchi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Takashi Miyata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Tomoko Kobayashi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mariko Sugiyama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Takeshi Onoue
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Daisuke Hagiwara
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Naoko Inoshita
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| |
Collapse
|
8
|
Vela-Patiño S, Salazar MI, Remba-Shapiro I, Peña-Martínez E, Silva-Roman G, Andoneui-Elguera S, Ordoñez-Garcia JDJ, Taniguchi-Ponciano K, Bonifaz L, Aguilar-Flores C, Marrero-Rodríguez D, Mercado M. Neuroendocrine-immune Interface: Interactions of Two Complex Systems in Health and Disease. Arch Med Res 2022; 53:240-251. [DOI: 10.1016/j.arcmed.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/25/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
|
9
|
Moriwaki M, Welt CK. PRL Mutation Causing Alactogenesis: Insights Into Prolactin Structure and Function Relationships. J Clin Endocrinol Metab 2021; 106:e3021-e3026. [PMID: 33770166 PMCID: PMC8277218 DOI: 10.1210/clinem/dgab201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Isolated prolactin deficiency is a rare disorder manifesting as absence of puerperal lactation. We identified a 2-generation family with 3 women experiencing alactogenesis. OBJECTIVE We hypothesized a heterozygous genetic mutation. METHODS This was a family-based study. Two generations of women (proband, sister, and niece) with puerperal alactogenesis and one control were studied. Prolactin levels in the 3 women ranged from 0.618 to 1.4 ng/mL (range, 2.8-29.2 ng/mL). All the women had regular menstrual cycles during their reproductive years. The niece required fertility treatment to become pregnant and the proband and sister underwent menopause before age 45 years. Prolactin gene (PRL) exons 1 to 5 were sequenced. We sought a heterozygous, deleterious gene variant with functional consequences. RESULTS We identified a heterozygous mutation (c.658C > T) changing CGA to TGA (p.Arg220Ter) in exon 5 of the prolactin gene. Transfection of PRL containing the stop gain mutation resulted in similar intracellular prolactin levels compared to PRL wild type, but little detectable immunoactive or bioactive prolactin in conditioned medium. Prolactin secretion was also impaired by a PRL stop gain mutation deleting both of the terminal cysteine amino acids (c.652A > T; p.Lys218Ter). CONCLUSION This is the first report of a PRL mutation causing familial prolactin deficiency and alactogenesis. The loss of the terminal cysteine resulted in failure of prolactin secretion. Secretion was not rescued by deleting the penultimate cysteine, with which it forms a disulfide bond. These data suggest that the PRL C terminal is critical for protein secretion.
Collapse
Affiliation(s)
- Mika Moriwaki
- Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, Utah 84112, USA
| | - Corrine K Welt
- Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, Utah 84112, USA
- Correspondence: Corrine K. Welt, MD, Division of Endocrinology, Metabolism and Diabetes, University of Utah, Eccles Institute of Human Genetics, 15 N 2030 E, Salt Lake City, UT 84112, USA.
| |
Collapse
|
10
|
Kobayashi T, Iwama S, Sugiyama D, Yasuda Y, Okuji T, Ito M, Ito S, Sugiyama M, Onoue T, Takagi H, Hagiwara D, Ito Y, Suga H, Banno R, Nishikawa H, Arima H. Anti-pituitary antibodies and susceptible human leukocyte antigen alleles as predictive biomarkers for pituitary dysfunction induced by immune checkpoint inhibitors. J Immunother Cancer 2021; 9:jitc-2021-002493. [PMID: 34011534 PMCID: PMC8137231 DOI: 10.1136/jitc-2021-002493] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pituitary dysfunction is a life-threatening immune-related adverse event (irAE) induced by immune checkpoint inhibitors (ICIs). To date, it is not possible to identify patients who may develop pituitary irAEs prior to ICI treatment. The aim of this study was to characterize the predisposition for ICI-induced pituitary irAEs by analyzing anti-pituitary antibodies (APAs) and human leukocyte antigens (HLAs). METHODS In this case-control study, APAs and HLA alleles were analyzed in 62 patients (17 who developed ICI-induced isolated adrenocorticotropic hormone deficiency (ICI-IAD), 5 who developed ICI-induced hypophysitis (ICI-H) and 40 who did not develop pituitary irAEs) treated with ICIs between November 2, 2015, and March 31, 2020, at Nagoya University Hospital. The main outcome measures in this study were the association between the development of pituitary irAEs with APAs at baseline and after treatment and HLA alleles. RESULTS Eleven of 17 (64.7%) patients who developed ICI-IAD had APAs at baseline, whereas APAs were positive only in 1 of 40 (2.5%) control patients. Although APAs were negative at baseline in all patients who developed ICI-H, they had become positive before the onset of ICI-H in 3 of 4 patients several weeks after ipilimumab administration. At the onset of ICI-IAD and ICI-H, APAs were positive in 15 of 17 (88.2%) and 4 of 5 (80%) patients, respectively. The prevalence of HLA-Cw12, HLA-DR15, HLA-DQ7, and HLA-DPw9 was significantly higher in patients with ICI-IAD, whereas that of HLA-Cw12 and HLA-DR15 was significantly higher in patients with ICI-H than in controls. CONCLUSIONS This study showed distinct and overlapped patterns of APAs and HLA alleles between ICI-IAD and ICI-H. Our findings also showed that positive APAs at baseline and after treatment, together with susceptible HLA alleles, could become predictive biomarkers for ICI-IAD and ICI-H, respectively. TRIAL REGISTRATION NUMBER UMIN000019024.
Collapse
Affiliation(s)
- Tomoko Kobayashi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daisuke Sugiyama
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshinori Yasuda
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takayuki Okuji
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Ito
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sachiko Ito
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mariko Sugiyama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takeshi Onoue
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroshi Takagi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daisuke Hagiwara
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshihiro Ito
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryoichi Banno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Aichi, Japan
| | - Hiroyoshi Nishikawa
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Division of Cancer Immunology, Research Institute/Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, Tokyo, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
11
|
Iwama S, Kobayashi T, Arima H. Clinical Characteristics, Management, and Potential Biomarkers of Endocrine Dysfunction Induced by Immune Checkpoint Inhibitors. Endocrinol Metab (Seoul) 2021; 36:312-321. [PMID: 33934588 PMCID: PMC8090479 DOI: 10.3803/enm.2021.1007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 01/17/2023] Open
Abstract
Immune-related adverse events (irAEs) affecting the endocrine glands are among the most frequent irAEs induced by immune checkpoint inhibitors (ICIs) and include hypopituitarism, primary adrenal insufficiency, thyrotoxicosis, hypothyroidism, hypoparathyroidism, and type 1 diabetes mellitus. Since the incidence and clinical features of endocrine irAEs vary according to the ICI used, it is important to understand the characteristics of these irAEs and to manage each one appropriately. Since some endocrine irAEs, including adrenal crisis and diabetic ketoacidosis, are potentially life-threatening, predicting the risk of endocrine irAEs before their onset is critical. Several autoantibodies have been detected in patients who develop endocrine irAEs, among which anti-thyroid antibodies may be predictive biomarkers of thyroid dysfunction. In this review, we describe the clinical features of each endocrine irAE induced by ICIs and discuss their potential biomarkers, including autoantibodies.
Collapse
Affiliation(s)
- Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Hospital, Nagoya, Japan
- Corresponding authors: Shintaro Iwama Department of Endocrinology and Diabetes, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan Tel: +81-52-744-2142, Fax: +81-52-744-2212 E-mail:
| | - Tomoko Kobayashi
- Department of Endocrinology and Diabetes, Nagoya University Hospital, Nagoya, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Corresponding authors: Shintaro Iwama Department of Endocrinology and Diabetes, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan Tel: +81-52-744-2142, Fax: +81-52-744-2212 E-mail:
| |
Collapse
|
12
|
LaPierre MP, Godbersen S, Torres Esteban M, Schad AN, Treier M, Ghoshdastider U, Stoffel M. MicroRNA-7a2 Regulates Prolactin in Developing Lactotrophs and Prolactinoma Cells. Endocrinology 2021; 162:6009069. [PMID: 33248443 PMCID: PMC7774778 DOI: 10.1210/endocr/bqaa220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 02/06/2023]
Abstract
Prolactin production is controlled by a complex and temporally dynamic network of factors. Despite this tightly coordinated system, pathological hyperprolactinemia is a common endocrine disorder that is often not understood, thereby highlighting the need to expand our molecular understanding of lactotroph cell regulation. MicroRNA-7 (miR-7) is the most highly expressed miRNA family in the pituitary gland and the loss of the miR-7 family member, miR-7a2, is sufficient to reduce prolactin gene expression in mice. Here, we used conditional loss-of-function and gain-of-function mouse models to characterize the function of miR-7a2 in lactotroph cells. We found that pituitary miR-7a2 expression undergoes developmental and sex hormone-dependent regulation. Unexpectedly, the loss of mir-7a2 induces a premature increase in prolactin expression and lactotroph abundance during embryonic development, followed by a gradual loss of prolactin into adulthood. On the other hand, lactotroph development is delayed in mice overexpressing miR-7a2. This regulation of lactotroph function by miR-7a2 involves complementary mechanisms in multiple cell populations. In mouse pituitary and rat prolactinoma cells, miR-7a2 represses its target Raf1, which promotes prolactin gene expression. These findings shed light on the complex regulation of prolactin production and may have implications for the physiological and pathological mechanisms underlying hyperprolactinemia.
Collapse
Affiliation(s)
- Mary P LaPierre
- Institute of Molecular Health Sciences, ETH Zürich, Zürich, Switzerland
| | - Svenja Godbersen
- Institute of Molecular Health Sciences, ETH Zürich, Zürich, Switzerland
| | | | - Anaïs Nura Schad
- Institute of Molecular Health Sciences, ETH Zürich, Zürich, Switzerland
| | - Mathias Treier
- Max Delbrück Zentrum für molekulare Medizin (MDC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Germany
| | | | - Markus Stoffel
- Institute of Molecular Health Sciences, ETH Zürich, Zürich, Switzerland
- Medical Faculty, University of Zürich, Zürich, Switzerland
- Correspondence: Markus Stoffel, Swiss Federal Institute of Technology, ETH Zürich, Institute for Molecular Health Science, HPL H36, Otto-Stern Weg 7, CH 8093 Zürich, Switzerland.
| |
Collapse
|
13
|
Abstract
Autoimmunity contributes to the pathogenesis of hypophysitis, a chronic inflammatory disease in the pituitary gland. Although primary hypophysitis is rare, the number of pituitary dysfunction cases induced by immune checkpoint inhibitors (ICIs) is increasing. While it is difficult to prove the involvement of autoimmunity in the pituitary glands, circulating anti-pituitary antibodies (APAs) can be measured by indirect immunofluorescence and used as a surrogate marker of pituitary autoimmunity. APAs are present in several pituitary diseases, including lymphocytic adenohypophysitis, lymphocytic infundibulo-neurohypophysitis (LINH), IgG4-related hypophysitis, and pituitary dysfunction induced by ICIs. Mass spectrometry analysis of antigens targeted by APAs clarified rabphilin-3A as an autoantigen in LINH. This demonstrates that APAs can be applied as a probe to identify novel autoantigens in other pituitary autoimmune diseases, including pituitary dysfunction induced by ICIs, which can aid in biomarker discovery.
Collapse
Affiliation(s)
- Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Hospital, Nagoya 466-8550, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| |
Collapse
|
14
|
Prado NA, Carlstead K, Malloy EJ, Paris S, Wielebnowski N, Rockwood LL, Brown JL. Ovarian cyclicity and prolactin status of African elephants (Loxodonta africana) in North American zoos may be influenced by life experience and individual temperament. Horm Behav 2020; 125:104804. [PMID: 32531397 DOI: 10.1016/j.yhbeh.2020.104804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/21/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
Hyperprolactinemia is an endocrine disorder associated with infertility in many species, including elephants. In a recent survey of zoos accredited by the Association of Zoos and Aquariums (AZA), over half of African elephant females (N = 101) were not cycling normally, 30% of which exhibited hyperprolactinemia. We examined whether life experience and temperament predict ovarian cyclicity and circulating prolactin status in individual African elephant females. We hypothesized that, similar to humans, acyclicity and hyperprolactinemia in elephants will be associated with an apprehensive or fearful, anxious temperament, and an increased number of potentially challenging life events (transfers, deaths and births). Ninety-five adult African elephant females housed at 37 AZA institutions were included in this study. Blood samples were collected twice a month for 1 year to determine ovarian cycle (cycling, n = 44; irregular, n = 13; non-cycling, n = 38) and prolactin (normal, n = 44; low; n = 23; high; n = 28) status. Keeper ratings on a 6-point scale were obtained on 32 temperament traits in 85 of these elephants. We determined that giving birth and being exposed to herd mates entering the facility were positively associated with normal ovarian cycle and prolactin profiles. By contrast, age, serum cortisol, and an increased number of herd mates leaving a facility were negatively associated with both. Contrary to our hypothesis, hyperprolactinemia was associated with a popular and caring temperament rating, whereas consistently low prolactin was associated with a fearful, apprehensive temperament. These findings indicate that pituitary-ovarian function may be impacted by life history (cyclicity) and temperament (prolactin), which should be taken into consideration when making management decisions.
Collapse
Affiliation(s)
- Natalia A Prado
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA.
| | - Kathy Carlstead
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Elizabeth J Malloy
- Department of Mathematics and Statistics, American University, 4400 Massachusetts Ave. NW, Washington, DC, USA
| | - Stephen Paris
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | | | - Larry L Rockwood
- Department of Biology, George Mason University, Fairfax, VA, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| |
Collapse
|
15
|
Golan Y, Assaraf YG. Genetic and Physiological Factors Affecting Human Milk Production and Composition. Nutrients 2020; 12:E1500. [PMID: 32455695 PMCID: PMC7284811 DOI: 10.3390/nu12051500] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
Human milk is considered the optimal nutrition for infants as it provides additional attributes other than nutritional support for the infant and contributes to the mother's health as well. Although breastfeeding is the most natural modality to feed infants, nowadays, many mothers complain about breastfeeding difficulties. In addition to environmental factors that may influence lactation outcomes including maternal nutrition status, partner's support, stress, and latching ability of the infant, intrinsic factors such as maternal genetics may also affect the quantitative production and qualitative content of human milk. These genetic factors, which may largely affect the infant's growth and development, as well as the mother's breastfeeding experience, are the subject of the present review. We specifically describe genetic variations that were shown to affect quantitative human milk supply and/or its qualitative content. We further discuss possible implications and methods for diagnosis as well as treatment modalities. Although cases of nutrient-deficient human milk are considered rare, in some ethnic groups, genetic variations that affect human milk content are more abundant, and they should receive greater attention for diagnosis and treatment when necessary. From a future perspective, early genetic diagnosis should be directed to target and treat breastfeeding difficulties in real time.
Collapse
Affiliation(s)
| | - Yehuda G. Assaraf
- The Fred Wyszkowski Cancer Research Laboratory, Department of Biology, Technion-Israel Institute of Technology, Haifa 3200003, Israel;
| |
Collapse
|
16
|
Sant' Anna BG, Musolino NRC, Gadelha MR, Marques C, Castro M, Elias PCL, Vilar L, Lyra R, Martins MRA, Quidute ARP, Abucham J, Nazato D, Garmes HM, Fontana MLC, Boguszewski CL, Bueno CB, Czepielewski MA, Portes ES, Nunes-Nogueira VS, Ribeiro-Oliveira A, Francisco RPV, Bronstein MD, Glezer A. A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas. Pituitary 2020; 23:120-128. [PMID: 31728906 DOI: 10.1007/s11102-019-01008-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the maternal-fetal outcomes of CAB-induced pregnancies in patients with prolactinoma in a large cohort. METHODS The prevalence of tumor growth, miscarriage, preterm, low birth weight, congenital malformations and impairment in neuropsychological development in children among women treated with CAB were assessed in a Brazilian multicentre retrospective observational study, RESULTS: We included 194 women with a mean age of 31 (17-45) years, 43.6% presenting microadenomas and 56.4% macroadenomas, at prolactinoma diagnosis. In 233 pregnancies, CAB was withdrawn in 89%, after pregnancy confirmation. Symptoms related to tumor growth occurred in 25 cases, more frequently in macroadenomas. The overall miscarriage rate was 11%, although higher in the subgroup of patients with CAB maintainance after pregnancy confirmation (38% vs. 7.5%). Amongst the live-birth deliveries, preterm occurred in 12%, low birth weight in 6% and congenital malformations in 4.3%. Neuropsychological development impairment was reported in 7% of cases. CONCLUSIONS Our findings confirm previous results of safety in maternal and fetal outcomes in CAB-induced pregnancies; nevertheless, CAB maintenance after pregnancy confirmation was associated with higher miscarriage rate; result that must be further confirmed.
Collapse
Affiliation(s)
- B G Sant' Anna
- Division of Endocrinology and Metabolism, Hospital das Clinicas, Neuroendocrine Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, no 155, 8° andar, bloco 3 (Endocrinologia), Sao Paulo, SP, 05403-000, Brazil.
| | - N R C Musolino
- Division of Neurosurgery, Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - M R Gadelha
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Marques
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Castro
- University of Sao Paulo Medical School of Ribeirao Preto, Ribeirao Preto, SP, Brazil
| | - P C L Elias
- University of Sao Paulo Medical School of Ribeirao Preto, Ribeirao Preto, SP, Brazil
| | - L Vilar
- Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - R Lyra
- Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - M R A Martins
- Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - A R P Quidute
- Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - J Abucham
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - D Nazato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - H M Garmes
- State University of Campinas, Campinas, SP, Brazil
| | | | - C L Boguszewski
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Parana, Curitiba, Parana, Brazil
| | - C B Bueno
- Irmandade da Santa Casa de Misericórdia de São Paulo, Sao Paulo, SP, Brazil
| | - M A Czepielewski
- Division of Endocrinology, Hospital de Clinicas de Porto Alegre (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - E S Portes
- Institute of Medical Assistance to the State Public Hospital, Sao Paulo, SP, Brazil
| | - V S Nunes-Nogueira
- São Paulo State University (UNESP), Medical School, Botucatu, SP, Brazil
| | - A Ribeiro-Oliveira
- Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - R P V Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - M D Bronstein
- Division of Endocrinology and Metabolism, Hospital das Clinicas, Neuroendocrine Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, no 155, 8° andar, bloco 3 (Endocrinologia), Sao Paulo, SP, 05403-000, Brazil
| | - A Glezer
- Division of Endocrinology and Metabolism, Hospital das Clinicas, Neuroendocrine Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, no 155, 8° andar, bloco 3 (Endocrinologia), Sao Paulo, SP, 05403-000, Brazil
| |
Collapse
|
17
|
Yamamoto M, Iguchi G, Bando H, Kanie K, Hidaka-Takeno R, Fukuoka H, Takahashi Y. Autoimmune Pituitary Disease: New Concepts With Clinical Implications. Endocr Rev 2020; 41:5568277. [PMID: 31513261 DOI: 10.1210/endrev/bnz003] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/11/2019] [Indexed: 01/21/2023]
Abstract
Some endocrine disorders, including hypophysitis and isolated adrenocorticotropic hormone (ACTH) deficiency, are caused by an autoimmune response to endocrine organs. Although the pathogenesis of some autoimmune endocrine diseases has been elucidated, it remains obscure for most. Anti-PIT-1 hypophysitis (anti-PIT-1 antibody syndrome) is a newly described pituitary autoimmune disease characterized by acquired and specific growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH) deficiencies. This disorder is associated with a thymoma or neoplasm that ectopically expresses pituitary-specific transcription factor 1 (PIT-1) protein. Circulating anti-PIT-1 antibody is a disease marker, and PIT-1-reactive cytotoxic T cells (CTLs) play a pivotal role in disease development. In addition, isolated ACTH deficiency appears to be caused by autoimmunity to corticotrophs; however, the pathogenesis remains unclear. A recently described case of isolated ACTH deficiency with large cell neuroendocrine carcinoma (LCNEC) showed ectopically expressed proopiomelanocortin (POMC), and circulating anti-POMC antibody and POMC-reactive CTLs were also detected. As CTL infiltrations around corticotrophs were also observed, isolated ACTH deficiency may be associated at least in part with a paraneoplastic syndrome. Although several underlying mechanisms for pituitary autoimmunity have been proposed, these observations highlight the importance of paraneoplastic syndrome as a cause of pituitary autoimmune disease. In this review, we focus on the pathophysiology and connection of anti-PIT-1 hypophysitis and isolated ACTH deficiency and discuss the state-of-art knowledge for understanding pituitary autoimmunity.
Collapse
Affiliation(s)
- Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | - Genzo Iguchi
- Bulletin of Medical Center for Student's Health Service, Kobe University, Kobe, Japan
| | - Hironori Bando
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Keitaro Kanie
- Division of Diabetes and Endocrinology Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
18
|
Gubbi S, Hannah-Shmouni F, Verbalis JG, Koch CA. Hypophysitis: An update on the novel forms, diagnosis and management of disorders of pituitary inflammation. Best Pract Res Clin Endocrinol Metab 2019; 33:101371. [PMID: 31866206 PMCID: PMC7078033 DOI: 10.1016/j.beem.2019.101371] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hypophysitis is a heterogeneous condition that leads to inflammation of the sella and/or suprasellar region, potentially resulting in hormonal deficiencies and/or mass effects. A preponderance of hypophysitis subtypes have an underlying autoimmune aetiology. The overall incidence and prevalence of hypophysitis has dramatically increased over the past decade, mainly due to increased awareness of the condition in the medical community, improvements in imaging techniques, and a rise in the occurrence of certain forms of hypophysitis such as IgG4 hypophysitis (IgG4Hy) and immune checkpoint inhibitor induced hypophysitis (ICIHy). The clinical presentation varies from an asymptomatic condition to a fatal disease often as a result of electrolyte abnormalities due to glucocorticoid deficiency in the context of adrenal crisis from central adrenal insufficiency. Milder forms of hypophysitis are treated with replacement of deficient hormones while more acute presentations with mass effects require glucocorticoid therapy, immunosuppressive therapy or surgery. Timely diagnosis and interventions are keys to prevention of the lethal complications of this disease. In this review, we provide an update on the recent advances in the field of pituitary autoimmunity, with an emphasis on autoimmune hypophysitis and novel forms of hypophysitis such as anti-PIT1 hypophysitis, IgG4Hy and ICIHy.
Collapse
Affiliation(s)
- Sriram Gubbi
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, 20892, USA.
| | - Fady Hannah-Shmouni
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, 20892, USA.
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University Medical Center, Washington, DC, 20007, USA.
| | - Christian A Koch
- The University of Tennessee Health Science Center, Memphis, TN, 38163, USA; Fox Chase Cancer Center, Philadelphia, PA, USA.
| |
Collapse
|
19
|
Trpc5 deficiency causes hypoprolactinemia and altered function of oscillatory dopamine neurons in the arcuate nucleus. Proc Natl Acad Sci U S A 2019; 116:15236-15243. [PMID: 31285329 DOI: 10.1073/pnas.1905705116] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Dopamine neurons of the hypothalamic arcuate nucleus (ARC) tonically inhibit the release of the protein hormone prolactin from lactotropic cells in the anterior pituitary gland and thus play a central role in prolactin homeostasis of the body. Prolactin, in turn, orchestrates numerous important biological functions such as maternal behavior, reproduction, and sexual arousal. Here, we identify the canonical transient receptor potential channel Trpc5 as an essential requirement for normal function of dopamine ARC neurons and prolactin homeostasis. By analyzing female mice carrying targeted mutations in the Trpc5 gene including a conditional Trpc5 deletion, we show that Trpc5 is required for maintaining highly stereotyped infraslow membrane potential oscillations of dopamine ARC neurons. Trpc5 is also required for eliciting prolactin-evoked tonic plateau potentials in these neurons that are part of a regulatory feedback circuit. Trpc5 mutant females show severe prolactin deficiency or hypoprolactinemia that is associated with irregular reproductive cyclicity, gonadotropin imbalance, and impaired reproductive capabilities. These results reveal a previously unknown role for the cation channel Trpc5 in prolactin homeostasis of female mice and provide strategies to explore the genetic basis of reproductive disorders and other malfunctions associated with defective prolactin regulation in humans.
Collapse
|
20
|
Abstract
The principal role of prolactin in mammals is the regulation of lactation. Prolactin is a hormone that is mainly synthesized and secreted by lactotroph cells in the anterior pituitary gland. Prolactin signalling occurs via a unique transmembrane prolactin receptor (PRL-R). The structure of the PRL-R has now been elucidated and is similar to that of many biologically fundamental receptors of the class 1 haematopoietic cytokine receptor family such as the growth hormone receptor. The PRL-R is expressed in a wide array of tissues, and a growing number of biological processes continue to be attributed to prolactin. In this Review, we focus on the newly discovered roles of prolactin in human health and disease, particularly its involvement in metabolic homeostasis including body weight control, adipose tissue, skin and hair follicles, pancreas, bone, the adrenal response to stress, the control of lactotroph cell homeostasis and maternal behaviour. New data concerning the pathological states of hypoprolactinaemia and hyperprolactinaemia will also be presented and discussed.
Collapse
Affiliation(s)
- Valérie Bernard
- Inserm U1185, Faculté de Médecine Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
- Hôpital Saint Antoine, Service d'Endocrinologie et des Maladies de la Reproduction, Paris, France
| | - Jacques Young
- Inserm U1185, Faculté de Médecine Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
- Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Paris, France
| | - Nadine Binart
- Inserm U1185, Faculté de Médecine Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France.
| |
Collapse
|
21
|
Prado NA, Paris SW, Brown JL. Prolonged ovarian acyclicity is associated with a higher likelihood of developing hyperprolactinemia in zoo female African elephants. Zoo Biol 2018; 38:180-188. [DOI: 10.1002/zoo.21464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Natalia A. Prado
- Department of Reproductive Sciences, Center for Species SurvivalSmithsonian Conservation Biology InstituteFront RoyalVirginia
| | - Stephen W. Paris
- Department of Reproductive Sciences, Center for Species SurvivalSmithsonian Conservation Biology InstituteFront RoyalVirginia
| | - Janine L. Brown
- Department of Reproductive Sciences, Center for Species SurvivalSmithsonian Conservation Biology InstituteFront RoyalVirginia
| |
Collapse
|
22
|
Berens PD, Villanueva M, Nader S, Swaim LS. Isolated Prolactin Deficiency: A Possible Culprit in Lactation Failure. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2018-0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
23
|
The Hypothalamic-Pituitary Axis and Autoantibody Related Disorders. Int J Mol Sci 2017; 18:ijms18112322. [PMID: 29099758 PMCID: PMC5713291 DOI: 10.3390/ijms18112322] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 12/22/2022] Open
Abstract
This review summarized different studies reporting the presence of autoantibodies reacting against cells of the pituitary (APAs) and/or hypothalamus (AHAs). Both APAs and AHAs have been revealed through immunofluorescence using different kinds of substrates. Autoantibodies against gonadotropic cells were mainly found in patients affected by cryptorchidism and hypogonadotropic hypogonadism while those against prolactin cells were found in different kinds of patients, the majority without pituitary abnormalities. APAs to growth hormone (GH) cells have been associated with GH deficiency while those against the adrenocorticotropic cells have distinguished central Cushing's disease patients at risk of incomplete cure after surgical adenoma removal. AHAs to vasopressin cells have identified patients at risk of developing diabetes insipidus. APAs have been also found together with AHAs in patients affected by idiopathic hypopituitarism, but both were also present in different kinds of patients without abnormalities of the hypothalamic-pituitary axis. Despite some data being promising, the clinical use of pituitary and hypothalamus autoantibodies is still limited by the low diagnostic sensitivity, irreproducibility of the results, and the absence of autoantigen/s able to discriminate the autoimmune reaction involving the pituitary or the hypothalamus from the other autoimmune states.
Collapse
|
24
|
Iwata N, Iwama S, Sugimura Y, Yasuda Y, Nakashima K, Takeuchi S, Hagiwara D, Ito Y, Suga H, Goto M, Banno R, Caturegli P, Koike T, Oshida Y, Arima H. Anti-pituitary antibodies against corticotrophs in IgG4-related hypophysitis. Pituitary 2017; 20:301-310. [PMID: 27896569 DOI: 10.1007/s11102-016-0780-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE IgG4-related disease is a systemic inflammatory disease characterized by infiltration of IgG4-positive plasma cells into multiple organs, including the pituitary gland. Autoimmunity is thought to be involved in the pathogenesis of IgG4-related disease. The diagnosis of IgG4-related hypophysitis (IgG4-RH) is difficult because its clinical features, such as pituitary swelling and hypopituitarism, are similar to those of other pituitary diseases, including lymphocytic hypophysitis and sellar/suprasellar tumors. The presence and significance of anti-pituitary antibodies (APA) in IgG4-RH is unclear. METHODS In this case-control study, we used single indirect immunofluorescence on human pituitary substrates to assess the prevalence of serum APA in 17 patients with IgG4-RH, 8 control patients with other pituitary diseases (lymphocytic infundibulo-neurohypophysitis, 3; craniopharyngioma, 2; germinoma, 3), and 9 healthy subjects. We further analyzed the endocrine cells targeted by the antibodies using double indirect immunofluorescence. RESULTS APA were found in 5 of 17 patients with IgG4-RH (29%), and in none of the pituitary controls or healthy subjects. The endocrine cells targeted by the antibodies in the 5 IgG4-RH cases were exclusively corticotrophs. Antibodies were of the IgG1 subclass, rather than IgG4, in all 5 cases, suggesting that IgG4 is not directly involved in the pathogenesis. Finally, antibodies recognized pro-opiomelanocortin in 2 of the cases. CONCLUSIONS Our study suggests that autoimmunity is involved in the pathogenesis of IgG4-RH and that corticotrophs are the main antigenic target, highlighting a possible new diagnostic marker for this condition.
Collapse
Affiliation(s)
- Naoko Iwata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan.
| | - Yoshihisa Sugimura
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Yoshinori Yasuda
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Kohtaro Nakashima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Seiji Takeuchi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Daisuke Hagiwara
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Yoshihiro Ito
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Motomitsu Goto
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Ryoichi Banno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
- Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Teruhiko Koike
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan
| | - Yoshiharu Oshida
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| |
Collapse
|
25
|
Bellastella G, Maiorino MI, Bizzarro A, Giugliano D, Esposito K, Bellastella A, De Bellis A. Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects. Pituitary 2016; 19:625-642. [PMID: 27503372 PMCID: PMC7088540 DOI: 10.1007/s11102-016-0736-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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.
Collapse
Affiliation(s)
- Giuseppe Bellastella
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Maria Ida Maiorino
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Antonio Bizzarro
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Dario Giugliano
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Antonio Bellastella
- Endocrinology and Metabolic Diseases Unit, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy.
| | - Annamaria De Bellis
- Endocrinology and Metabolic Diseases Unit, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy
| |
Collapse
|
26
|
Ricciuti A, Travison TG, Di Dalmazi G, Talor MV, DeVincentiis L, Manley RW, Bhasin S, Caturegli P, Basaria S. A Subset of Men With Age-Related Decline in Testosterone Have Gonadotroph Autoantibodies. J Clin Endocrinol Metab 2016; 101:1535-41. [PMID: 26963952 PMCID: PMC4880156 DOI: 10.1210/jc.2016-1016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT Age-related decline in serum testosterone (T) is being increasingly diagnosed. In most men, it associates with low or inappropriately normal gonadotropin levels, which suggests a hypothalamic-pituitary etiology. Autoantibodies against adenohypophyseal cells have been associated with pituitary dysfunction; however, the prevalence of pituitary autoimmunity in this age-related T decline has not been assessed. OBJECTIVES This is a proof-of-concept study with the objective of determining the prevalence of antibodies to gonadotrophs in older men with age-related low T and compare it with healthy young and older eugonadal men. STUDY DESIGN This is a cross-sectional case-control study of 182 men. Cases included 100 older men (≥65 years) with age-related low T levels; the control groups were composed of 50 young and 32 older healthy eugonadal men. Serum antibodies against the anterior pituitary gland were measured using a two-step approach: 1) single indirect immunofluorescence (ie, participant serum only) to determine the pattern of cytosolic staining; and 2) double indirect immunofluorescence (ie, participant serum plus a commercial adenohypophyseal hormone antibody) to identify the anterior pituitary cell type recognized by the patient's antibodies). RESULTS In participants with positive antipituitary antibodies, the granular cytosolic pattern (highly predictive of pituitary autoimmunity) was only seen in older men with age-related low T (4%) and none in control groups (0%, P = .001). Double indirect immunofluorescence confirmed that pituitary antibodies were exclusively directed against the gonadotrophs. CONCLUSION A subset of older men with age-related low T levels have specific antibodies against the gonadotrophs. Whether these antibodies are pathogenic and contributory to the age-related decline in T remains to be established.
Collapse
|
27
|
Iwama S, Sugimura Y, Kiyota A, Kato T, Enomoto A, Suzuki H, Iwata N, Takeuchi S, Nakashima K, Takagi H, Izumida H, Ochiai H, Fujisawa H, Suga H, Arima H, Shimoyama Y, Takahashi M, Nishioka H, Ishikawa SE, Shimatsu A, Caturegli P, Oiso Y. Rabphilin-3A as a Targeted Autoantigen in Lymphocytic Infundibulo-neurohypophysitis. J Clin Endocrinol Metab 2015; 100:E946-54. [PMID: 25919460 PMCID: PMC5393526 DOI: 10.1210/jc.2014-4209] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/22/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Central diabetes insipidus (CDI) can be caused by several diseases, but in about half of the patients the etiological diagnosis remains unknown. Lymphocytic infundibulo-neurohypophysitis (LINH) is an increasingly recognized entity among cases of idiopathic CDI; however, the differential diagnosis from other pituitary diseases including tumors can be difficult because of similar clinical and radiological manifestations. The definite diagnosis of LINH requires invasive pituitary biopsy. OBJECTIVE The study was designed to identify the autoantigen(s) in LINH and thus develop a diagnostic test based on serum autoantibodies. DESIGN Rat posterior pituitary lysate was immunoprecipitated with IgGs purified from the sera of patients with LINH or control subjects. The immunoprecipitates were subjected to liquid chromatography-tandem mass spectrometry to screen for pituitary autoantigens of LINH. Subsequently, we made recombinant proteins of candidate autoantigens and analyzed autoantibodies in serum by Western blotting. RESULTS Rabphilin-3A proved to be the most diagnostically useful autoantigen. Anti-rabphilin-3A antibodies were detected in 22 of the 29 (76%) patients (including 4 of the 4 biopsy-proven samples) with LINH and 2 of 18 (11.1%) patients with biopsy-proven lymphocytic adeno-hypophysitis. In contrast, these antibodies were absent in patients with biopsy-proven sellar/suprasellar masses without lymphocytic hypophysitis (n = 34), including 18 patients with CDI. Rabphilin-3A was expressed in posterior pituitary and hypothalamic vasopressin neurons but not anterior pituitary. CONCLUSIONS These results suggest that rabphilin-3A is a major autoantigen in LINH. Autoantibodies to rabphilin-3A may serve as a biomarker for the diagnosis of LINH and be useful for the differential diagnosis in patients with CDI.
Collapse
MESH Headings
- Adaptor Proteins, Signal Transducing/immunology
- Adaptor Proteins, Signal Transducing/metabolism
- Adult
- Animals
- Autoantibodies/blood
- Autoantigens/immunology
- Autoimmune Diseases/blood
- Autoimmune Diseases/immunology
- Autoimmune Diseases/metabolism
- Diabetes Insipidus, Neurogenic/blood
- Diabetes Insipidus, Neurogenic/diagnosis
- Diabetes Insipidus, Neurogenic/immunology
- Diabetes Insipidus, Neurogenic/metabolism
- Diagnosis, Differential
- Female
- HEK293 Cells
- Humans
- Lymphocytes/immunology
- Male
- Nerve Tissue Proteins/immunology
- Nerve Tissue Proteins/metabolism
- Pituitary Gland, Posterior/immunology
- Pituitary Gland, Posterior/metabolism
- Rats
- Rats, Sprague-Dawley
- Vesicular Transport Proteins/immunology
- Vesicular Transport Proteins/metabolism
- Young Adult
- Rabphilin-3A
Collapse
Affiliation(s)
- Shintaro Iwama
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Yoshihisa Sugimura
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Atsushi Kiyota
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Takuya Kato
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Atsushi Enomoto
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Haruyuki Suzuki
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Naoko Iwata
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Seiji Takeuchi
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Kohtaro Nakashima
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Hiroshi Takagi
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Hisakazu Izumida
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Hiroshi Ochiai
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Haruki Fujisawa
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Yoshie Shimoyama
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Masahide Takahashi
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Hiroshi Nishioka
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - San-e Ishikawa
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Akira Shimatsu
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Patrizio Caturegli
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| | - Yutaka Oiso
- Department of Endocrinology and Diabetes (S.Iw., Y.Su., A.K., H.S., N.I., S.T., K.N., H.T., H.I., H.O., H.F., H.S., H.A., Y.O.) and Department of Pathology (T.K., A.E., M.T.), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Research Center of Health, Physical Fitness and Sports (S.Iw.), Nagoya University, Nagoya 464-8601, Japan; Department of Pathology and Clinical Laboratory (Y.Sh.), Nagoya University Hospital, Nagoya 466-8560, Japan; Department of Hypothalamic and Pituitary Surgery (H.N.), Toranomon Hospital, Tokyo 105-0001, Japan; Department of Medicine (S.Is.), Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Clinical Research Institute (A.S.), National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan; Department of Pathology (P.C.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Feinstone Department of Molecular Microbiology and Immunology (P.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; and Japan Hypophysitis Research Group (S.Iw., Y.Su., H.N., S.Is., A.S., Y.O.), Nagoya 466-8550, Japan
| |
Collapse
|
28
|
Callejas L, Berens P, Nader S. Breastfeeding failure secondary to idiopathic isolated prolactin deficiency: report of two cases. Breastfeed Med 2015; 10:183. [PMID: 25763845 DOI: 10.1089/bfm.2015.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Leyda Callejas
- 1 Department of Internal Medicine (Endocrinology), University of Texas Health Science Center , Houston, Texas
| | | | | |
Collapse
|
29
|
Potic A, Popovic V, Ostojic J, Pekic S, Kozic D, Guerrero K, Schiffmann R, Bernard G. Neurogenic bladder and neuroendocrine abnormalities in Pol III-related leukodystrophy. BMC Neurol 2015; 15:22. [PMID: 25868523 PMCID: PMC4351912 DOI: 10.1186/s12883-015-0283-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/20/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pol III-related leukodystrophies, including 4H leukodystrophy, are recently recognized disorders that comprise hypomyelination and various neurologic and non-neurologic clinical manifestations. We report the unique neurologic presentation of the micturition dysfunction in Pol III-related leukodystrophy and describe the novel endocrine abnormalities in this entity. CASE PRESENTATION A 32-year-old Caucasian female exhibited chronic urinary incontinence that commenced at the age of 7 years and remained the unexplained symptom more than two decades before the onset of progressive neurologic decline. A transient growth failure and absent sexual development with hypoprolactinemia appeared in the meanwhile. Neurologic, endocrine, neuroradiologic, and genetic evaluation performed only in the patient's thirties, confirmed the diagnosis of 4H leukodystrophy as the only cause of the micturition disturbance. CONCLUSION The report shows for the first time that an unexplained chronic bladder dysfunction should be evaluated also as a possible 4H leukodystrophy, thus alerting to the unexpected neurologic and endocrine features in 4H leukodystrophy.
Collapse
|
30
|
Kiyota A, Iwama S, Sugimura Y, Takeuchi S, Takagi H, Iwata N, Nakashima K, Suzuki H, Nishioka T, Kato T, Enomoto A, Arima H, Kaibuchi K, Oiso Y. Identification of the novel autoantigen candidate Rab GDP dissociation inhibitor alpha in isolated adrenocorticotropin deficiency. Endocr J 2015; 62:153-60. [PMID: 25346144 DOI: 10.1507/endocrj.ej14-0369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Isolated adrenocorticotropin deficiency (IAD) is characterized by low or absent adrenocorticotropic hormone (ACTH) production. IAD is presumed to be caused in part by an autoimmune mechanism, and several lines of evidence have suggested the presence of anti-pituitary antibodies in IAD. However, the exact autoantigens remain unknown. The present study was designed to identify the autoantigen(s) in IAD using chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Rat anterior pituitary lysate was subjected to SDS-PAGE, and immunoblotting was performed using the sera from two patients with IAD and from a healthy subject. The bands detected by the patient serum samples, but not by the healthy subject sample, were excised, in-gel digested using trypsin, and subjected to LC-MS/MS analysis. On immunoblots, a 51-kDa band in the insoluble pellet was detected by the sera from the IAD patients but not from the healthy subject. Mass spectrometric analysis revealed the 51-kDa band contained Rab guanine nucleotide dissociation inhibitor (GDI) alpha. Consistent with the mass spectrometric analysis, a recombinant full-length human Rab GDI alpha was recognized by the two IAD patient samples but not by the healthy subject sample using immunoblotting. In total, anti-Rab GDI alpha antibodies were detected in serum samples from three of five patients with IAD (60%) but were absent in 5 healthy subjects. In addition, Rab GDI alpha was expressed in the anterior pituitary. In conclusion, it appears that Rab GDI alpha is a candidate autoantigen involved in IAD, and that anti-Rab GDI alpha antibodies are present predominantly in patients with IAD.
Collapse
Affiliation(s)
- Atsushi Kiyota
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Marasco LA. Unsolved Mysteries of the Human Mammary Gland: Defining and Redefining the Critical Questions from the Lactation Consultant's Perspective. J Mammary Gland Biol Neoplasia 2014; 19:271-88. [PMID: 26084427 DOI: 10.1007/s10911-015-9330-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023] Open
Abstract
Despite advances in knowledge about human lactation, clinicians face many problems when advising mothers who are experiencing breastfeeding difficulties that do not respond to normal management strategies. Primary insufficient milk production is now being acknowledged, but incidence rates have not been well studied. Many women have known histories of infertility, polycystic ovary syndrome, obesity, hypertension, insulin resistance, thyroid dysfunction, hyperandrogenism or other hormonal imbalances, while others have no obvious risk factors. Some present with obviously abnormal breasts that are pubescent, tuberous/tubular or asymmetric in shape, raising the question of insufficient mammary gland tissue. Other women have breasts that appear within normal limits yet do not lactate normally. Endocrine disruptors may underlie some of these cases but their impact on human milk production has not been well explored. Similarly, any problem with prolactin such as a deficiency in serum prolactin or receptor number, receptor resistance, or poor bioavailability or bioactivity could underlie some cases of insufficient lactation, yet these possibilities are rarely investigated. A weak or suppressed milk ejection reflex, often assumed to be psychosomatic, could be related to thyroid dysfunction or caused by downstream post-receptor pathway problems. In the absence of sufficient data regarding these situations, desperate mothers may turn to non-evidence-based remedies, sometimes at considerable cost and unknown risk. Research targeted to these clinical dilemmas is critical in order to develop evidence-based strategies and increase breastfeeding duration and success rates.
Collapse
|
32
|
Iwama S, De Remigis A, Callahan MK, Slovin SF, Wolchok JD, Caturegli P. Pituitary expression of CTLA-4 mediates hypophysitis secondary to administration of CTLA-4 blocking antibody. Sci Transl Med 2014; 6:230ra45. [PMID: 24695685 DOI: 10.1126/scitranslmed.3008002] [Citation(s) in RCA: 449] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hypophysitis is a chronic inflammation of the pituitary gland of unknown (primary forms) or recognizable (secondary forms) etiology, such as the use of ipilimumab in cancer immunotherapy. Ipilimumab, which blocks the T cell inhibitory molecule CTLA-4 (cytotoxic T lymphocyte antigen-4), induces hypophysitis in about 4% of patients through unknown mechanisms. We first established a model of secondary hypophysitis by repeated injections of a CTLA-4 blocking antibody into SJL/J or C57BL/6J mice, and showed that they developed lymphocytic infiltration of the pituitary gland and circulating pituitary antibodies. We next assessed the prevalence of pituitary antibodies in a cohort of 20 patients with advanced melanoma or prostate cancer, 7 with a clinical diagnosis of hypophysitis, before and after ipilimumab administration. Pituitary antibodies, negative at baseline, developed in the 7 patients with hypophysitis but not in the 13 without it; these antibodies predominantly recognized thyrotropin-, follicle-stimulating hormone-, and corticotropin-secreting cells. We then hypothesized that the injected CTLA-4 antibody could cause pituitary toxicity if bound to CTLA-4 antigen expressed "ectopically" on pituitary endocrine cells. Pituitary glands indeed expressed CTLA-4 at both RNA and protein levels, particularly in a subset of prolactin- and thyrotropin-secreting cells. Notably, these cells became the site of complement activation, featuring deposition of C3d and C4d components and an inflammatory cascade akin to that seen in type II hypersensitivity. In summary, the study offers a mechanism to explain the pituitary toxicity observed in patients receiving ipilimumab, and highlights the utility of measuring pituitary antibodies in this form of secondary hypophysitis.
Collapse
Affiliation(s)
- Shintaro Iwama
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | | | | | | | | | | |
Collapse
|
33
|
De Bellis A, Bellastella G, Colella C, Bizzarro A, Bellastella A, Esposito K. Use of serum pituitary antibodies to improve the diagnosis of hypophysitis. Expert Rev Endocrinol Metab 2014; 9:465-476. [PMID: 30736209 DOI: 10.1586/17446651.2014.932689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lymphocytic hypophysitis is characterized by an extensive infiltration of lymphocytic cells. Pituitary biopsy is the gold diagnostic standard for lymphocytic hypophysitis but the disease occurs with moderate or without pituitary enlargement. The role of antipituitary antibodies (APA) in autoimmune hypophysitis is still discussed due to various methodological difficulties. Indirect immunofluorescence, a widely employed method to detect APA at this time produces highly variable results due to the use of human or animal pituitary substrates. For many years the authors have conducted a re-evaluation of APA by immunofluorescence in patients with other autoimmune diseases and in patients with apparently idiopathic hypopituitarism, using pituitary from young baboons as substrate but considering a predetermined cut-off of the titer and immunofluorescence pattern. This procedure allowed us to find out those with autoimmune pituitary impairment and to foresee the kind of future hypopituitarism in those with pituitary function still normal. Moreover, in APA positive patients, the use of a second step of a double immunofluorescence method allowed identification of the pituitary cells targeted by APA, verifying the correspondence with the kind of hypopituitarism, also when present in subclinical stage. However, to carry out an international workshop comparing the detection of APA by immunofluorescence using different substrates could contribute to verify the best choice to improve the sensitivity and specificity of this method.
Collapse
Affiliation(s)
- Annamaria De Bellis
- a Chair of Endocrinology and Metabolism, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
- c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Giuseppe Bellastella
- a Chair of Endocrinology and Metabolism, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
- c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Caterina Colella
- a Chair of Endocrinology and Metabolism, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
- c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Antonio Bizzarro
- b Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
- c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Antonio Bellastella
- a Chair of Endocrinology and Metabolism, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
- c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- b Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
- c Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, Italy
| |
Collapse
|