Detection of vasopressin cell antibodies in some patients with autoimmune endocrine diseases without overt diabetes insipidus

Bellis, Annamaria De; Bizzarro, Antonio; Paglionico, Vanda Amoresano; Martino, Sergio Di; Criscuolo, T.; Sinisi, Antonio Agostino; Lombardi, Gaetano; Bellastella, Antonio

doi:10.1111/j.1365-2265.1994.tb02464.x

Cited by 39 publications

(23 citation statements)

References 16 publications

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“…The natural history of LYH is also similar to other autoimmune endocrine diseases (73,115), progressing through several stages (5,73) in which the different histopathological features are paralleled with corresponding clinical aspects. At disease onset the pituitary gland is enlarged, edematous and with lymphocytic infiltration, putting pressure on adjacent structures.…”

Section: Etiopathogenesismentioning

confidence: 79%

Lymphocytic hypophysitis: a rare or underestimated disease?

Bellastella

Bizzarro²,

Coronella³

et al. 2003

Eur J Endocrinol

197

205

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Lymphocytic hypophysitis (LYH) is an uncommon autoimmune disease in which the pituitary gland is infiltrated by lymphocytes, plasma cells and macrophages and its function is usually impaired. It has to be suspected in pregnant women and in women with recent delivery presenting with hyperprolactinemia, headache, visual field alterations and changes of one or more pituitary hormone secretions with secondary impairment of related peripheral target glands, especially when associated with other autoimmune endocrine or non-endocrine disorders. It can also occur less frequently in prepubertal or post-menopausal women and in men. Headache, visual field impairment and more rarely diplopia are due to extrasellar pituitary enlargement with optic chiasma compression and/or to invasion of cavernous sinuses. Among the 'isolated' pituitary hormone deficiencies, ACTH deficit is usually the earliest and most frequent hormonal impairment and in rare cases can induce an acute secondary hyposurrenalism as the first sign of the disease, with high mortality in affected patients. Histopathological findings from pituitary biopsy show lymphoplasmacytic infiltrate with lymphoid aggregates surrounding atropic acini of pituitary cells; immunohistochemical analysis shows numerous mast cells randomly distributed and also localized in the vicinity of capillaries, suggesting a possible influence on capillary permeability and angiogenesis, thus favoring the inflammatory and immunological aggression against pituitary cells. Nuclear magnetic resonance imaging shows uniform sellar floor depression and an extrasellar symmetrical pituitary enlargement, usually displacing the optic chiasma, which shows a rapid homogeneous enhancement after gadolinium also involving the adjacent dura (dural tail). Antipituitary antibodies have been detected in several patients with LYH but their role needs to be clarified. Since a possible spontaneous remission can occur, a careful follow-up is required in subclinical patients without important hyposurrenalism or symptomatic extrasellar expansion. Medical (immunosuppressive, replacement and antiprolactinemic) and neurosurgical (decompression) treatments are needed in clinical symptomatic patients.

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Section: Etiopathogenesismentioning

confidence: 79%

Lymphocytic hypophysitis: a rare or underestimated disease?

Bellastella

Bizzarro²,

Coronella³

et al. 2003

Eur J Endocrinol

197

205

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show abstract

“…In particular, FITC conjugated with goat anti-human IgG was used to detect the presence of AHAs and APAs. Sera of patients positive for AHAs were re-tested by four-layer double immunofluorescence to verify whether the hypothalamic cells targeted by AHAs were AVP-secreting cells (12,13,14). For this purpose, in a second step, the same hypothalamus section was tested consecutively against the patient's serum and the rabbit antisera anti-AVP, followed by rhodamine goat sera anti-rabbit IgG.…”

Section: Aha Avpcab and Apa Evaluationmentioning

confidence: 99%

“…AHAs and APAs were detected by simple indirect immunofluorescence method on cryostat sections of young baboon hypothalamus and pituitary, respectively, supplied by Biosystem Italia Srl (San Martino Buon Albergo, VR, Italy), as described previously (14,15). In particular, FITC conjugated with goat anti-human IgG was used to detect the presence of AHAs and APAs.…”

Section: Aha Avpcab and Apa Evaluationmentioning

confidence: 99%

Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

Bellastella

Bizzarro

Aitella

et al. 2015

European Journal of Endocrinology

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Recently, an increased incidence of central diabetes insipidus (CDI) in pregnancy, and less frequently in the post partum period, has been reported, most probably favoured by some conditions occurring in pregnancy. This study was aimed at investigating the influence of pregnancy on a pre-existing potential/subclinical hypothalamic autoimmunity. We studied the longitudinal behaviour of arginine-vasopressin cell antibodies (AVPcAbs) and post-pituitary function in two young women with a positive history of autoimmune disease and presence of AVPcAbs, but without clinical CDI, and who became pregnant 5 and 7 months after our first observation. The behaviour of post-pituitary function and AVPcAbs (by immunofluorescence) was evaluated at baseline, during pregnancy and for 2 years after delivery. AVPcAbs, present at low/middle titres at baseline in both patients, showed a titre increase during pregnancy in one patient and after delivery in the other patient, with development of clinically overt CDI. Therapy with 1-deamino-8-D-arginine vasopressin (DDAVP) caused a prompt clinical remission. After a first unsuccessful attempt of withdrawal, the therapy was definitively stopped at the 6th and the 7th month of post partum period respectively, when AVPcAbs disappeared, accompanied by post-pituitary function recovery, persisting until the end of the follow-up. The determination of AVPcAbs is advisable in patients with autoimmune diseases planning their pregnancy, because they could be considered good predictive markers of gestational or post partum autoimmune CDI. The monitoring of AVPcAb titres and post-pituitary function during pregnancy in these patients may allow for an early diagnosis and an early replacement therapy, which could induce the disappearance of these antibodies with consequent complete remission of CDI.

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“…Cytoplasmic antibodies to AVP-secreting cells were determined by indirect immunofluorescence [2,8], on cryostat sections of young baboon hypothalamus. Fluorescein isothiocyanate (FITC)-conjugated goat anti-human immunoglobulin sera (IgG.…”

Section: Immunological Studymentioning

confidence: 99%

“…Central idiopathic diabetes insipidus (DI) can be asso ciated with other endocrine autoimmune diseases, espe cially thyroid diseases and less frequently Addison's dis ease or insulin-dependent diabetes mellitus (IDDM) [1][2][3][4][5][6][7], Moreover, arginine vasopressin (AVP)-secreting cell antibodies (Abs) can also be detected in some patients with endocrine autoimmune disease without DI [8]. On the other hand, patients with idiopathic DI can show posi tivity, not only for AVP-secreting cell Abs, but also for other organ-specific Abs [2,6,9].…”

Section: Introductionmentioning

confidence: 99%

Association of Arginine Vasopressin-Secreting Cell, Steroid-Secreting Cell, Adrenal and Islet Cell Antibodies in a Patient Presenting with Central Diabetes insipidus, Empty Sella, Subclinical Adrenocortical Failure and Impaired Glucose Tolerance

Bellis

Bizzarro²,

Martino³

et al. 1995

Horm Res

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A 36-year-old woman with central diabetes insipidus (DI), diagnosed when she was 7, was referred to our Endocrine Unit in January 1993 for further hormonal investigations. Clinical and laboratory findings confirmed the diagnosis of central DI. Cranial computed tomography and magnetic resonance imaging showed only an empty sella. Moreover, we noted impaired glucose tolerance and unusual findings of subclinical adrenocortical failure, i.e. high plasma renin activity with normal aldosterone levels, high ACTH despite normal basal and ACTH-stimulated cortisol levels. Immunological study of the patient’s serum showed the presence of arginine vasopressin (AVP)-secreting cell antibodies (Abs), steroid-producing cell Abs, adrenal and islet cell Abs. The following aspects of our case are stressed and discussed: (1) the presence of AVP-secreting cell Abs 29 years after the diagnosis of DI; (2) the association between DI, empty sella and subclinical autoimmune adrenocortical failure with unusual hormonal findings, and (3) impaired glucose tolerance with islet cell antibody positivity.

show abstract

Detection of vasopressin cell antibodies in some patients with autoimmune endocrine diseases without overt diabetes insipidus

Cited by 39 publications

References 16 publications

Lymphocytic hypophysitis: a rare or underestimated disease?

Lymphocytic hypophysitis: a rare or underestimated disease?

Pregnancy may favour the development of severe autoimmune central diabetes insipidus in women with vasopressin cell antibodies: description of two cases

Association of Arginine Vasopressin-Secreting Cell, Steroid-Secreting Cell, Adrenal and Islet Cell Antibodies in a Patient Presenting with Central Diabetes insipidus, Empty Sella, Subclinical Adrenocortical Failure and Impaired Glucose Tolerance

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