Pituitary Autoimmunity in patients with Sheehan's syndrome
Pituitary Autoimmunity in patients with Sheehan's syndrome
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DOI：
10.1210/jc.2001-020242
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发表时间：
2002-09-01
影响因子：
5.8
通讯作者：
Gupta, N
中科院分区：
文献类型：
--
作者：
Goswami, R;Kochupillai, N;Gupta, N
产后出血（PPH）是印度常见的妊娠并发症。Sheehan对产后垂体功能减退症的描述促进了PPH导致妊娠期垂体肿大坏死和垂体功能减退症的信念。然而，缓慢的临床进展表明其发病机制中存在缺血以外的因素。组织坏死可释放隔离的抗原，触发垂体自身免疫和迟发性垂体功能减退。研究了26例连续的产后垂体功能减退症患者，其中19例为希恩综合征，基于PPH病史和提示垂体衰竭的激素谱[平均（SD）年龄32.7 ± 6.4岁，病程5.5 ± 3.1年]，7例无PPH病史，归类为“其他”。对垂体显像和基础T（4）、TSH、皮质醇、LH、FSH、17 β-雌二醇以及抗垂体（PitAb）和甲状腺（TKA）自身抗体进行了评估。对照组包括28名健康女性，无既往妊娠史（22 +/- 5岁）和28名既往妊娠史（26 +/- 5岁）。12/19例（63.1%）希恩综合征患者和1/7例其他组患者有抗49-kDa自身抗原的PitAb;神经元特异性烯醇化酶。28例无妊娠史的对照组中有4例（14.2%）PitAb阳性，28例有妊娠史的对照组中有5例（17.8%）PitAb阳性（与Sheehan综合征相比，P分别< 0.001和< 0.01）。Sheehan综合征患者与其他组以及PitAb阳性或阴性患者之间的平均血清激素值和TMA阳性无显著差异。PPH后垂体功能减退可能与垂体自身免疫有关。
Postpartum hemorrhage (PPH) is a frequent complication of pregnancy in India. Sheehan's description of postpartum hypopituitarism promoted the belief that PPH leads to necrosis of the enlarged pituitary gland of pregnancy and hypopituitarism. However, slow clinical progression suggests factors other than ischemia in its pathogenesis. Tissue necrosis could release sequestered antigens, triggering autoinimunity of the pituitary and delayed hypopituitarism in Sheehan's syndrome. Twenty-six consecutive patients with postpartum hypopituitarism were studied, 19 with Sheehan's syndrome based on a history of PPH and hormone profile suggesting pituitary failure [mean (SD) age 32.7 +/- 6.4 yr, duration of illness 5.5 +/- 3.1 yr], and seven patients with no history of PPH, categorized as "Other." Pituitary imaging and basal T(4), TSH, cortisol, LH, FSH, 17beta-estradiol, and autoantibodies against pituitary (PitAb) and thyroid (TKA) were evaluated. Controls included 28 healthy females without prior conception (22 +/- 5 yr) and 28 with prior conception (26 +/- 5 yr). Twelve of 19 (63.1%) patients with Sheehan's syndrome and one of seven in the Other group had PitAb against the 49-kDa autoantigen; neuron-specific enolase. Four of 28 (14.2%) controls without prior conception and 5 of 28 (17.8%) controls with prior conception had PitAb positivity (P < 0.001 and < 0.01 vs. Sheehan's syndrome, respectively). There was no significant difference in the mean serum hormone values and TMA positivity between patients with Sheehan's syndrome and the Other group as well as patients with or without PitAb positivity. Pituitary autoimmunity may play a role in the cause of hypopituitarism following PPH.