Antipituitary antibodies against gonadotropin-secreting cells in adult male patients with apparently idiopathic hypogonadotropic hypogonadism.

CONTEXT: Hypogonadotropic hypogonadism (HH) can occur at any stage of life as an isolated congenital or acquired abnormality or within a more generalized pituitary or hypothalamic impairment. However, the defect in patients with idiopathic HH is still unknown. OBJECTIVE: The aim of this study was to investigate the prevalence of antipituitary antibodies (APA) in a group of HH patients with or without Kallmann's syndrome and to characterize their pituitary target. DESIGN: We conducted a cross-sectional cohort study. SETTING: The study was performed at the Endocrinology Unit of the Second University of Naples. PATIENTS: Twenty-one HH patients with normal sense of smell (group 1), 10 patients with Kallmann's syndrome (group 2), 13 patients with HH associated with other pituitary hormone deficiencies (group 3), and 50 normal controls were studied. MAIN OUTCOME MEASURES: APA were evaluated in patients and in controls by indirect immunofluorescence. Moreover, a magnetic resonance imaging (MRI) of the hypothalamic-pituitary region was performed in all three groups of patients. RESULTS: APA were detected at high titer in eight out of 21 patients in group 1 (38%) and in five of 13 in group 3 (38.4%), and at low titers in two out of 10 in group 2 (20%) and in three of 50 controls (6%). In patients of group 1, APA immunostained selectively gonadotropin-secreting cells, whereas in those of group 3, they immunostained other pituitary hormone-secreting cells also. None of patients in group 1 showed alterations on MRI, whereas all patients in group 2 showed aplasia/hypoplasia of the olfactory bulbs/tracts and/or of olfactory sulci. Among the five APA-positive patients in group 3, three had normal MRI, one had findings of empty sella, and one had findings of autoimmune hypophysitis. CONCLUSIONS: Our results suggest that some apparently idiopathic cases of HH, both isolated and associated with other pituitary impairment, can be caused by an early autoimmune process involving the gonadotrophs at pituitary level. Future longitudinal studies are needed to clarify the natural history of this process and the possible effect of early corticosteroid therapy.

Immunocytochemical localization and ultrastructural study of gonadotroph cells in the female desert lizard Uromastyx acanthinura.

The pars distalis from the pituitary gland of adult female desert lizards (Uromastyx acanthinura), captured during vitellogenesis (late may) and hivernal period, was studied with immunocytochemical methods using specific antisera against human FSH (hFSH) and LH (hLH). The immunostaining with anti-hLH and anti-hFSH allowed the identification of only FSH-like containing cells. The FSH-like immunoreactive cells were affected differently by a physiological stage and showed some heterogenous cytological characteristics. During vitellogenesis, four aspects of rostral FSH-like immunoreactive cells could be recognized. The expression of FSH-like in mainly immunoreactive cells was parallel to an intense synthetic activity and to the presence of ultrastructural features indicating an intense release of the hormone. This release was considerably altered in winter, the immunoreactive cells stored an important amount of secretion granules which increased in size and undergo a crinophagic process.

Homologous desensitization with gonadotropin-releasing hormone (GnRH) also diminishes gonadotrope responsiveness to maitotoxin: a role for the GnRH receptor-regulated calcium ion channel in mediation of cellular desensitization.

Maitotoxin (MTX) stimulates gonadotropin release from pituitary cell cultures. The time course and efficacy of LH release in response to GnRH and to MTX are similar; both secretagogues require extracellular Ca2+ and are inhibited by the selective Ca2+ ion channel antagonist methoxyverapamil (D600). LH release in response to either GnRH or MTX is not measurably inhibited by two other chemical classes of Ca2+ ion channel inhibitors represented by nifedipine and by diltiazem. The two secretagogues are nonadditive in their action on LH release when presented at high doses and prior studies indicate that MTX has no endogenous ionophoretic activity. These observations indicate that MTX likely stimulates LH release due to activation of the GnRH receptor associated Ca2+-ion channel in the gonadotrope. We have therefore assessed the functional state of this channel during the development of homologous desensitization of the gonadotrope to GnRH by measuring the ability of MTX to stimulate LH release. Cells were desensitized with GnRH in the presence of 3 mM EGTA. Under these conditions, the cells become refractory to GnRH in the absence of gonadotropin release since the latter process, but not the former, requires extracellular Ca2+. Accordingly, this approach allows assessment of the degree of desensitization in the absence of the influence of gonadotropin depletion. Such desensitized cells are less responsive to GnRH. Desensitized pituitary cells also respond with diminished efficacy and potency to MTX three or more hours after GnRH treatment but not at an earlier time (1 h) when GnRH receptors are diminished. These data are consistent with a model in which homologous desensitization is viewed as developing in two phases.(ABSTRACT TRUNCATED AT 250 WORDS)

Estradiol has inverse effects on pituitary glycoprotein hormone alpha-subunit messenger ribonucleic acid in the immature European eel and the gonadectomized rat.

In teleosts, the pituitary contains a single glycoprotein gonadotropic hormone (GTH) composed of two dissimilar alpha- and beta-subunits. The European eel, Anguilla anguilla L, is sexually immature at the silver stage due to a deficiency in GTH synthesis and secretion. In previous studies we (S.D., YA.F.) have demonstrated a strong stimulatory action of estradiol (E2) on eel pituitary GTH content. In contrast, we (R.C., M.J.) have shown that in the rat E2 negatively regulates gonadotropin subunit synthesis via changes in specific mRNA levels. The purpose of our present work was to check for such effects of E2 on the synthesis of GTH alpha- and beta-subunits in the European eel. Eel pituitary mRNA was translated in a cell-free system in the presence of [35S]Met + Cys. We demonstrate that one of the translated polypeptides, characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography, cross-reacts with an antiserum to denatured bovine alpha-subunit. Its apparent mol wt (18.5K), which is slightly higher than that of the corresponding rat alpha-precursor, suggests that it represents the precursor of the alpha-subunit of eel glycoprotein hormones. The specificity of immunoprecipitation was confirmed by competition with ovine alpha (but not with ovine LH beta or bovine TSH beta). Quantitative evaluation of the putative eel alpha-subunit precursor showed that it represents 0.2% of the total protein translated by RNA from the normal silver eel. Chronic treatment of eels for 3 weeks with 17 beta-E2 increased by 8.0- to 8.5-fold the proportion of the putative alpha-subunit precursor among translation products. Due to the lack of cross-reactivity with the presumed GTH beta precursor, no radioactive material could be specifically detected in translation medium of eel pituitary mRNA using antisera to either denatured bovine LH beta or ovine FSH beta. Our data suggest that E2, depending on vertebrate group and probably on sexual status, may exert either positive or negative control on gonadotropin synthesis by opposite effects on the levels of specific mRNA.

Isolated adrenocorticotropin deficiency associated with an autoantibody to a corticotroph antigen that is not adrenocorticotropin or other proopiomelanocortin-derived peptides.

A 44-yr-old man with hypocortisolism was shown to have an undetectable basal plasma ACTH level and absent or subnormal ACTH and beta-lipotropin responses to provocative testing with insulin, vasopressin, and CRH. Endocrine function after glucocorticoid replacement was otherwise normal, thus establishing the diagnosis of isolated ACTH deficiency. This patient's serum was tested immunohistochemically for the presence of an antipituitary antibody by indirect immunofluorescence of rat pituitary tissue. Positive immunostaining was observed in stellate-shaped cells in the anterior and intermediate lobes. Immunopositive cells were shown by immunoelectron microscopy to have ultrastructural characteristics of corticotrophs. Immunoreactivity was concentrated in secretory granules 120-170 nm in diameter. In a double immunolabeling procedure, staining by the patient's serum was shown to colocalize with rabbit antiserum to ACTH, but not with antisera to PRL, GH, beta TSH, or beta LH. Immunoabsorption of the patient's serum with ACTH-(1-24), ACTH-(1-39), gamma MSH, corticotropin-like intermediate lobe peptide, beta-endorphin, or beta-lipotropin failed to diminish immunolabeling in the pituitary. We conclude that the antipituitary antibody in this patient's serum shows immunohistochemical specificity for a rat corticotroph antigen located in secretory granules that is neither ACTH nor any of the proopiomelanocortin (POMC)-derived peptides tested. The autoantigen could be a cell-specific granular factor involved in the posttranslational processing of POMC or secretion of ACTH. We postulate that an autoimmune process may account for this patient's disease, and that his antipituitary antibody could play a pathogenic role by either inhibiting a POMC-processing enzyme or initiating an antibody-dependent cell-mediated cytotoxicity reaction, resulting in the selective destruction of corticotrophs.

The effect of immunizing female rats with modified rat pituitary extract.

Immune reactions to a number of hormones have been induced, but information is lacking on the feasibility of inducing immune reactions to homologous gonadotropins. Female rats immunized with diazotized and tyrosylated rat pituitary extract containing gonadotropic activity and emulsified in complete Freund's adjuvant expressed various reproductive disturbances such as increased cycle length (7.0 days), increased number of sterile matings, reduced implantation in animals becoming pregnant, and reduced ability to carry fetuses to term. These effects were not exhibited by rats immunized similarly with diazotized or tyrosylated rat pituitary extract containing no detectable gonadotropic activity. Rats not becoming pregnant had a significantly higher antibody level to rat luteinizing hormone than did rats becoming pregnant. No significant elevation of rat follicle-stimulating hormone antibodies was noted. It is concluded that auto-immune reactions to gonadotropins can be induced and that very low levels of antibodies have a significant effect on reproduction.

The adenohypophysis of the swamp eel, Synbranchus marmoratus, an immunocytochemical analysis.

The adenohypophyseal cell types of the protogynous fish Synbranchus marmoratus were studied by histochemical and immunocytochemical staining with antisera raised against piscine and human pituitary hormones to ascertain their distribution. The prolactin (PRL) cells were distributed in the rostral pars distalis and showed specific binding to antisera to carp and chum salmon prolactin. No reaction was observed with antiserum to human prolactin. The corticotrops showed strong immunoreactivity with anti-human ACTH, these cells bordered the neurohypophysis and islets between PRL cells in the rostral pars distalis. Growth hormone (GH) cells were densely distributed and associated with the neurohypophysis only in pars distalis proximal. They reacted with antisera to piscine GH but not with antisera to human growth hormone. The thyrotrops were scattered in the proximal pars distalis and showed strong immunoreactivity to the human thyrotropin Beta subunit antiserum. Gonadotrops were located in the central area of the proximal pars distalis and in the external border of the pars intermedia. These cells were alcian blue and PAS positive, and reacted with anti-croaker GTH and anti-coho GTH I and GTH II. The PAS positive cells from the pars intermedia bound specifically to anti-chum somatolactin.

Brain-periphery connections: do they play a role in mediating the effect of centrally injected interleukin-1 beta on gonadal function?

The immune system and several endocrine axes communicate with each other through a network of molecules which collectively produce a coordinated response to immune challenges. This phenomenon, necessary for the survival of the organism, is thought to involve the release, by activated cells in the periphery, of proteins, called cytokines, which inform the brain about immune activation. The brain then organizes a series of neuroendocrine responses which participate in the regulation of the host response. With regard to the influence of cytokines on the hypothalamic-pituitary-gonadal axis, we know that the injection of these proteins lowers gonadotropin-releasing hormone release, which in turn inhibits luteinizing hormone (LH) secretion. These changes would be expected to decrease sex steroid production and, indeed, estrogens and testosterone are low in female and male rats, respectively, following acute intracerebroventricular (i.c.v.) injection of interleukin (IL)-1 beta. There is, however, another possibility that central cytokines could alter ovarian and testicular function independently of changes in gonadotropin levels. Prolonged i.c.v. infusion of the cytokine into the female rat brain produced a dramatic rise in progesterone levels. The absence of a comparable change in the progesterone release rate of males infused with IL-1 beta, and the presence of marked surges of prolactin (PRL) in the females, suggests that IL-1 beta altered ovarian function, and that the persistence of large corpora lutea induced PRL release. The possibility that the cytokine might stimulate the brain circuits that regulate PRL release, while possible, appears remote, because male rats injected with IL-1 beta showed significantly blunted PRL levels. In intact adult male rats, i.c.v. IL-1 beta administration caused the expected decrease in LH and testosterone levels, but was also accompanied by a loss of testicular responsiveness to gonadotropins. Though elevated levels of corticosteroids are known to interfere with normal gonadal steroidogenesis, blockade of IL-1-induced corticosterone release did not reverse the inhibitory influence of the cytokine. One mechanism that deserves attention is the possibility that i.c.v. injection of IL-1 beta might increase circulating cytokine levels, and indeed plasma IL-6 concentrations were significantly elevated in rats treated with IL-1 beta. This humoral mechanism may disrupt testicular function through the documented inhibitory effects of blood-borne cytokines on Leydig cell function. In addition, brain cytokines might influence a variety of peripheral events through direct (neural?) connections. This brief review discusses the hypothesis that there are brain-to-gonad connections that bypass the pituitary, and presents results that might support the possibility that central injection of IL-1 beta decreases testosterone secretion independently of blunted LH levels.

Immunocytochemistry of gonadotropic cells in the pituitary of some teleost species.

An antiserum (anti-sGTH) raised against salmon gonadotropin (SG-G100) was tested on pituitary sections of Sarotherodon mossambicus, Carassius auratus, Anguilla anguilla (intact and estradiol-treated to induce the development of the gonadotropic (GTH) cells), Salmo trutta fario, and a protandric marine teleost (Sarpa salpa, Sparidae). Using an immunoenzymologic technique, anti-sGTH stained GTH and thyrotropic (TSH) cells in the species studied. Anti-sGTH stained the granulated GTH cells in S. trutta fario and S. salpa; the vacuolated cells remained faintly stained or unlabeled in most cases. The results are discussed in the light of cytological, ultrastructural, and biochemical data which suggest that two forms of GTH cells may be present in some teleost pituitaries.

[Anaphylactogenic properties of Bulgarian gonadotropic preparations]. / Prouchvaniia vurkhu anafilaktogennite svoistva na bulgarski gonadotropni preparati.

Laboratory and clinical studies were carried out to elucidate the anaphylactogenic qualities of the Bulgarian goinadotropic preparations PMS (an untreated and a freeze-dried formula), gravohormone, and luteoziman. Comparatively was assessed the sensitivity of three methods employed in the routine determination of drug anaphylactogenicity. One of them is the author's personal modification of a pharmacopeia method (U. S. P. XVII)--sensibilizing doses were introduced in guinea pigs subcutaneously, once daily, in the course of three days at 3-day intervals. The resolution dose was applied intraperitoneally on the 10th day following the last sensibilizing dose. The manifestation of anaphylaxia were recorded immediately after the introduction of the resolution dose or two hours later (at the very latest). Studies revealed that the preparations tested had no equal anaphylactic properties. In guinea pigs, sheep, and cattle PMS induced allergic reactions in 50 per cent of the examined series. In these animals both gravohormone and luteoziman did not generate such response. Suggested is the use of a U. S. P. XVII modified method (as cited above) to determine the anaphylactogenicity of gonadotropic preparations; it makes it possible to qualify such preparations for a shorter time. The new modification is readily applicable at a production control basis.

Immunocytological determination of gonadotropic and thyrotropic cells in fetal rat anterior pituitary during normal development and under experimental conditions.

The appearance and relative distribution of immunoreactive gonadotropic and thyrotropic cells of the anterior pituitary of normal rat fetuses were studied by immunocytology with anti-rat luteinizing hormone serum, anti-porcine luteinizing hormone beta serum, anti-bovine thyrotropic hormone serum after saturation with bovine luteinizing hormone. The thyrotropic cells appeared at 17 days of gestation. They were preferentially localized in the dorsal part of the anterior lobe. The gonadotropic cells localized in the ventral part of the same lobe, appeared 1 day later. The number of immunoreactive cells of the two populations increased until the end of gestation. In the pituitaries of 21-day-old rat fetuses encephalectomized at 16 days of gestation, the same number of gonadotropic and thyrotropic cells was observed as in control fetuses at the same age. Gonadotropic cells were also observed in rat adenohypophysial primordia explanted at 14 days of gestation and maintained in organ culture for 7 days. Thyrotropic cells were stained when the primordia were explanted at 15 days of gestation and cultured for 6 days. No immunoreactive gonadotropic or thyrotropic cells were detected when explantation was performed before 14 days of gestation. These results clarify the problem of the role of hypothalamus on the differentiation of these two cell types.

Gonadotrofinomas: análisis multicéntrico y retrospectivo de 66 pacientes / Gonadotrophinomas: multicenter and retrospective analysis of 66 patients

Objetivo: Analizar la presentación clínica, radiológica, bioquímica y el comportamiento posquirúrgico de una cohorte de pacientes portadores de gonadotrofinomas. Pacientes y Métodos: Se evaluaron pacientes con gonadotrofinomas estudiados en nueve centros endocrinológicos de la ciudad de Bs.As. durante el período 1983 a 2003. El criterio de inclusión fue la inmunohistoquímica (IH) positiva para hormona luteinizante (LH), folículoestimulante (FSH) y/o alfa subunidad (ASU). Los adenomas plurihormonales fueron excluidos. Resultados: Fueron analizados 66 pacientes de 51,8 ± 12,1 (X +/- DS) años (39 varones). Los síntomas mas frecuentemente observados fueron las alteraciones visuales (72,8%), seguidas por el hipogonadismo y las cefaleas. El 10,6% se diagnosticaron en forma incidental. El 98,5% fueron macroadenomas, 56,9% de los cuales correspondieron a un estadio Hardy (EH) 3 y 29,6% a un EH 4. El tiempo de seguimiento fue de 47,8 meses (r: 5-168). El hipogonadismo definido bioquímicamente se presentó en el 82,4% de los pacientes. En su mayoría presentaban niveles bajos o inapropiadamente normales de gonadotrofinas, pero 4 mujeres y 3 varones presentaron niveles séricos elevados y disociados de FSH y LH. La hiperprolactinemia por desconexión fue observada en 45,2% de la población (X: 65.6 ng/ml r: 30-172). El hipopituitarismo se detectó en 25,7% de los casos. La cirugía fue transeptoesfenoidal (TSE) en 80%; una segunda operación fue realizada en el 28% de la población. La IH fue positiva por orden de frecuencia para LH, FSH y ASU o las 3 combinaciones. La evolución posquirúrgica evidenció mejoría en el campo visual (CV) en el 41%. La presencia de restos tumorales y/o recidiva fue del 84%. Se indicó radioterapia en 37% y la sustitución hormonal fue necesaria en el 65% de los pacientes.

The aim of our study was to describe the clinical-biochemical and radiologic presentation and the post surgery outcome in a cohort of patients with gonadotrophinomas. Patients were selected from nine Endocrinology Units of the city of Buenos Aires from 1983 at 2003. The inclusion criteria was defined by nonfunctinoning pituitary adenomas with positive innmunohistochemical (IH) for luteinizing hormone (LH), follicle-stimulating hormone (FSH) and/or alpha subunit (ASU). Innmunohistochemically plurihormonal adenomas were excluded. Sixty six patients were analyzed, aged 51,8 ± 12,1 (X +/- DS) years; (39 men). More prevalent symptoms were visual alterations (72,8%), hypogonadism and headaches. Eleven percent was diagnosed as incidentalomas. Ninety eight percent were macroadenomas, 56,9% was Hardy stage (HS) 3 and 29,6% was HS 4. The patients were followed up for 47,8 months (r: 5-168). Hypogonadism was biochemically found in 82,4%. The majority showed low or inappropriately normal levels of gonadotrophins except for 4 women and 3 men that had high and dissociated levels. Hyperprolactinemia was observed in 45,2% and was interpreted as an interference with normal dopamine inhibition of prolactin secretion (X+/-DS: 65.6+/- ng/ml, r: 30-172). Hypopituitarism was found in 25,7% of the patients. Transsphenoidal surgery was carried out in 80% and in 28% a second surgery was needed. The IH was positive for LH, FSH and ASU in this order of frequency or its combinations. Tumor persistency and/or recurrency were found in 84% of the patients. Forty one percent showed improvement of visual defects. Radiotherapy was indicated in 37% and hormonal replacement was needed in 65% of the patients.

Development of a heterologous radioimmunoassay for eel (Anguilla anguilla) gonadotropin.

A heterologous radioimmunoassay (RIA) for eel gonadotropin (GTH) was developed, using an antiserum to the beta subunit of carp GTH (cGTHbeta). Partially purified eel GTH preparations or crude eel pituitary extracts produced partial cross-reactions: the inhibition curves reached a plateau before complete inhibition of the binding of the tracer and the slopes were lower than those for cGTH. However, the parallelism between the inhibition curves produced by all the eel samples allowed estimation of their GTH activity relative to an eel GTH standard; under these conditions, the RIA exhibited good reproducibility within and between assays. Three different RIA systems for cGTHbeta using different antisera gave similar estimations of immunoreactive GTH (irGTH) content of eel GTH preparations and pituitary extracts. The specificity of teh heterologous RIA for eel GTH was first assessed by comparing RIA and bioassay data: as with carp pituitary extracts, no significant difference was found between immunological and biological estimations of GTH activity for partially purified or crude pituitary extracts from normal female eel. Further validation of the specificity of the RIA for eel GTH was provided by the variation of the eel pituitary irGTH content under different hormonal treatments: a significant increase in female eel pituitary irGTH content was produced by treatment with estradiol-17 beta or with carp pituitary extract, a result in agreement with previous histological reports of Olivereau and collaborators. The heterologous RIA for eel GTH, in view of its sensitivity, reproducibility, and specificity, is a useful tool for physiological studies in the eel.

Immunological cross-reactivity between rainbow trout GTH I and GTH II and their alpha and beta subunits: application to the development of specific radioimmunoassays.

Immunological cross-reactivities between rainbow trout GTH I and GTH II and their alpha and beta have been studied using highly purified rainbow trout gonadotropins and subunits and antibodies raised against beta subunits. From these observations radioimmunoassays have been developed for rainbow trout GTH I and GTH II. The GTH II RIA was highly specific and cross-reacted only with GTH II and its beta 1 subunits, with beta 2 being less potent than beta 1 in competing GTH II binding. There was no cross-reactivity with GTH I. Its sensitivity varied between 0.1 and 0.2 ng/ml, allowing GTH II measurement early in the reproductive cycle. Variations between and within assays were less than 10%. There was a lack of specificity of GTH I RIA (44% cross-reactivity with GTH II, when using labelled native GTH I). Reasons for this lack of sensitivity were studied. It cannot be attributed to beta subunits (less than 1.2% cross-reactivity). However, the cross-reactivity of alpha subunits was very important. This suggests that the presence of free alpha subunits in the medium can be responsible for the lack of specificity. Labelling native GTH I resulted in conformational change in molecular weight and dissociation of the hormone into subunits, whereas iodination did not induce GTH II dissociation. This dissociation can be avoided by labelling the stable form of GTH I. Using this radio-tracer, the specificity and the sensitivity of the assay were greatly improved (GTH II cross-reactivity was decreased to 3.7, mean sensitivity 0.87 +/- 0.072 ng/ml). The sensitivity of the assay diminished with ageing of labelled GTH I. The assay variation was 4.6% within an assay and 9.8% between assays. The use of labelled beta GTH I still increases the specificity (2.3% GTH II cross-reactivity), but with a 2.4-fold loss of sensitivity. In both GTH I and GTH II RIA plasma and spiked plasma with purified GTHs gave displacement curves parallel to standard. These assays were used to study pituitary responsiveness to a GnRH analogue in female rainbow trout prior to oocyte maturation. The effects of GnRH on GTH II secretion were confirmed. The peptide did not significantly stimulate GTH I secretion.

Preparation and use of specific antibodies to the beta-I and beta-II subunits of gonadotropic hormone from Fundulus heteroclitus pituitary.

Fundulus heteroclitus naturally spawns with a semilunar periodicity throughout most of the year in its southernmost habitat, an activity that can be maintained in the laboratory. The alpha and two beta subunits comprising F. heteroclitus gonadotropic hormones (GtHs) I and II have been sequenced, and antibodies have been raised against unique peptides found in each of the two beta subunits. On immunoblots of pituitary proteins, each antibody recognizes a single band with a molecular mass of 16-17 kDa, somewhat larger than the deduced sizes (11-13 kDa) of the unglycosylated subunits. Each antibody also recognizes a different subset of pituitary cells in the central (GtH I) and peripheral (GtH II) proximal pars distalis, regions that display the typical tinctorial properties of gonadotrops. The distribution and distinct separation of cells containing GtH beta subunits I and II thus differ from those found for previously described teleost species, most of which are salmonids that engage in a single spawning episode during the year. The availability of these antibodies thus makes F. heteroclitus an inexpensive, easily manipulated model system for studies on the hormonal regulation of fractional spawning common to a large class of commercially important species other than salmonids.