A new serum test for the differential diagnosis of pituitary masses

描述(申请人提供)：脑下垂体肿块(鞍区肿块)很常见，约占所有颅内肿块的15%。大约一半的鞍区肿块是由荷尔蒙分泌的腺瘤引起的，由于典型的体征和症状更容易被诊断出来。然而，其余的鞍区肿块不分泌任何激素(32%是无功能的垂体腺瘤，10%是非腺瘤性病变)，因此更难鉴别。通常只有在经蝶窦手术和病理检查后才能确诊。在无功能的垂体肿块中，自身免疫性(淋巴细胞性)垂体炎是唯一具有免疫发病机制的疾病。针对垂体炎的脑下垂体自身抗原尚不清楚。如果被发现，它们可以导致一种血清测试的发展，有助于区分垂体炎和其他无功能的脑下垂体肿块。这一区别对患者护理至关重要：事实上，垂体炎通常可以通过医学手段进行治疗，而其他情况通常需要手术治疗。该提案报告说，我们的人和小鼠的研究旨在发现垂体自身抗原，从而开发一种基于抗体的血清学测试，用于鉴别诊断无功能的垂体肿块。公共卫生相关性：脑下垂体肿块很常见。由于大多数患者不分泌任何脑下垂体激素，往往要在手术和病理检查后才能确诊。自身免疫性垂体炎是无功能垂体肿块中唯一具有免疫发病机制的疾病实体。这笔赠款旨在开发一种基于抗体的血清学测试，以帮助对这些常见疾病的鉴别诊断。这种检测可以避免对自身免疫性垂体炎患者进行不必要的垂体手术。

DESCRIPTION (provided by applicant): Masses of the pituitary gland (sellar masses) are common, representing approximately 15% of all intracranial masses. About half of the sellar masses are caused by a hormone-secreting adenoma and more easily diagnosed because of classical signs and symptoms. The remaining sellar masses, however, do not secrete any hormone (32% are non-functioning pituitary adenomas, and 10% are non-adenomatous lesions), and are therefore more difficult to differentiate. Often their diagnosis is established only after transsphenoidal surgery and pathological examination. Among the group of non-functioning pituitary masses, autoimmune (lymphocytic) hypophysitis is the only disease that has an immune pathogenesis. The pituitary autoantigens targeted in hypophysitis remain unknown. If discovered, they can lead to the development of a serum test useful to distinguish hypophysitis from the other non-functioning pituitary masses. This distinction is critical for patient care: in fact, hypophysitis can be usually managed medically, whereas the other conditions typically require surgery. The proposal reports our human and mouse studies aimed to discover the pituitary autoantigens and therefore develop an antibody-based serologic test for the differential diagnosis of non-functioning pituitary masses. PUBLIC HEALTH RELEVANCE: Pituitary masses are common. Because most of them do not secrete any pituitary hormone, they can often be diagnosed only after surgery and pathological examination. Autoimmune hypophysitis is the only disease entity among the non-functioning pituitary masses that has an immune pathogenesis. This grant is designed to develop an antibody- based serologic test to aid in the differential diagnosis of these common conditions. Such test could avoid unnecessary pituitary surgeries to patients with autoimmune hypophysitis.