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1.
Horm Metab Res ; 54(3): 153-161, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35276740

RESUMO

SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T3, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19.


Assuntos
Hormônio Adrenocorticotrópico/sangue , COVID-19/imunologia , Hipotálamo/imunologia , Hipófise/imunologia , Adulto , Autoanticorpos/sangue , Autoimunidade , COVID-19/sangue , COVID-19/metabolismo , COVID-19/virologia , Estudos de Casos e Controles , Feminino , Humanos , Hidrocortisona/sangue , Hipotálamo/metabolismo , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Hipófise/metabolismo , Prolactina/sangue , Estudos Prospectivos , SARS-CoV-2/fisiologia , Testosterona/sangue
2.
J Clin Endocrinol Metab ; 106(12): e5147-e5155, 2021 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-34254637

RESUMO

CONTEXT: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe chronic illness that reduces the quality of life. A potential role of neuroendocrine autoimmune dysfunction has been hypothesized. OBJECTIVE: This work aims to investigate the occurrence of antipituitary (APA) and antihypothalamic (AHA) antibodies and possible related hypothalamic/pituitary dysfunctions in ME/CSF patients. METHODS: This is a case-control study conducted in a university hospital setting (Stanford, California, USA; and Naples, Italy). Thirty women with ME/CSF (group 1) diagnosed according to Fukuda, Canadian, and Institute of Medicine criteria, at Stanford University, were enrolled and compared with 25 age-matched healthy controls. APA and AHA were detected by immunofluorescence; moreover, we investigated hormonal secretions of anterior pituitary and respective target glands. APA and AHA titers both were assessed and the prevalence of pituitary hormone deficiencies was also investigated. RESULTS: Patients in group 1 showed a high prevalence of AHA (33%) and APA (56%) and significantly lower levels of adrenocorticotropin (ACTH)/cortisol, and growth hormone (GH) peak/insulin-like growth factor-1 (IGF-1) vs controls (all AHA/APA negative). Patients in group 1A (13 patients positive at high titers, ≥ 1:32) showed ACTH/cortisol and GH peak/IGF-1 levels significantly lower and more severe forms of ME/CFS with respect to patients in group 1B (7 positive at middle/low titers, 1:16-1:8) and 1C (10 antibody-negative patients). CONCLUSION: Both AHA and/or APA at high titers were associated with hypothalamic/pituitary dysfunction, suggesting that hypothalamic/pituitary autoimmunity may play an important role in the manifestations of ME/CFS, especially in its more severe forms.


Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/epidemiologia , Biomarcadores/sangue , Síndrome de Fadiga Crônica/fisiopatologia , Hipotálamo/patologia , Doenças da Hipófise/epidemiologia , Hormônio Adrenocorticotrópico/sangue , Adulto , Autoanticorpos/imunologia , Doenças Autoimunes/sangue , Doenças Autoimunes/imunologia , Doenças Autoimunes/patologia , Estudos de Casos e Controles , Feminino , Seguimentos , Hormônio do Crescimento Humano/sangue , Humanos , Hipotálamo/imunologia , Hipotálamo/metabolismo , Fator de Crescimento Insulin-Like I/análise , Doenças da Hipófise/sangue , Doenças da Hipófise/imunologia , Doenças da Hipófise/patologia , Prognóstico , Estados Unidos/epidemiologia , Adulto Jovem
3.
Pituitary ; 22(3): 236-248, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30847776

RESUMO

PURPOSE: Traumatic brain injury (TBI) is one of the most common causes of mortality and long-term disability and it is associated with an increased prevalence of neuroendocrine dysfunctions. Post-traumatic hypopituitarism (PTHP) results in major physical, psychological and social consequences leading to impaired quality of life. PTHP can occur at any time after traumatic event, evolving through various ways and degrees of deficit, requiring appropriate screening for early detection and treatment. Although the PTHP pathophysiology remains to be elucitated, on the basis of proposed hypotheses it seems to be the result of combined pathological processes, with a possible role played by hypothalamic-pituitary autoimmunity (HPA). This review is aimed at focusing on this possible role in the development of PTHP and its potential clinical consequences, on the basis of the data so far appeared in the literature and of some results of personal studies on this issue. METHODS: Scrutinizing the data so far appeared in literature on this topic, we have found only few studies evaluating the autoimmune pattern in affected patients, searching in particular for antipituitary and antihypothalamus autoantibodies (APA and AHA, respectively) by simple indirect immunofluorescence. RESULTS: The presence of APA and/or AHA at high titers was associated with an increased risk of onset/persistence of PTHP. CONCLUSIONS: HPA seems to contribute to TBI-induced pituitary damage and related PTHP. However, further prospective studies in a larger cohort of patients are needed to define etiopathogenic and diagnostic role of APA/AHA in development of post-traumatic hypothalamic/pituitary dysfunctions after a TBI.


Assuntos
Autoimunidade/fisiologia , Lesões Encefálicas Traumáticas/patologia , Hipopituitarismo/patologia , Hipófise/patologia , Animais , Lesões Encefálicas Traumáticas/imunologia , Humanos , Hipopituitarismo/imunologia , Hipotálamo/metabolismo , Hipotálamo/patologia , Hipófise/imunologia
4.
Endocrine ; 62(3): 733-736, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29968227

RESUMO

The role of antipituitary antibodies in the pathophysiology of pituitary hormone deficiency has been increasingly elucidated over the last decade. Prader-Willi syndrome is a genetic disorder which includes hypothalamic/pituitary dysfunction as one of its main features. We looked for autoimmune pituitary involvement in 55 adults with Prader-Willi syndrome, discovering that about 30% of them have a positive titer of antipituitary antibodies. Although the presence of these autoantibodies could only be an "epiphenomenon", our results suggest that autoimmune mechanisms might contribute, at least in part, to the pituitary impairment of Prader-Willi syndrome, and in addition to genetically determined dysfunction of the central nervous system. This paper provides a new perspective on pituitary impairment in these patients, suggesting that the search for hypophisitis could be a reasonable and interesting field for further research.


Assuntos
Autoanticorpos/imunologia , Hipopituitarismo/imunologia , Hipófise/imunologia , Síndrome de Prader-Willi/imunologia , Adulto , Feminino , Humanos , Hipotálamo/imunologia , Masculino , Adulto Jovem
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