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Antipituitary antibodies after traumatic brain injury: Is head trauma induced pituitary dysfunction associated with autoimmunity?

F Tanriverdi, Endocrinology, Erciyes University Medical School,, Kayseri, Turkey
A De Bellis, Chair of Endocrinology, Second University of Naples, Via S. Pansini, 5, 80131 Naples, Naples, Italy
A Bizzarro, Chair of Immunology, Second University of Naples, Via S. Pansini, 5, 80131 Naples, Naples, Italy
A Sinisi, Naples, Italy
G Bellastella, Naples, Italy
E Pane, Chair of Endocrinology, Second University of Naples, Via S. Pansini, 5, 80131 Naples, Naples, Italy
A Bellastella, Naples, Italy
K Unluhizarci, Endocrinology, Erciyes University Medical School,, Kayseri, Turkey
A Selcuklu, Neurosurgery, Erciyes University Medical School, Kayseri, Turkey
F Casanueva, Medicine, School of Medicine and Complejo Hospitalario Universitario de Santiago, Santiago de Compostela University,, Santiago de Compostela, Spain
F Kelestimur, Endocrinology, Erciyes University Medical School, Kayseri, 38039, Turkey

Correspondence: Fahrettin Kelestimur, Email: fktimur{at}erciyes.edu.tr

Abstract

Objective: Traumatic brain injury (TBI) is a devastating public health problem which may result in hypopituitarism. Although the antibodies against neurons have been demonstrated in injured animal studies, investigations regarding the occurrence of antipituitary antibodies (APA) in patients with TBI are lacking in the literature.

In order to investigate whether autoimmune mechanisms could play a role in the pituitary dysfunction after TBI, we have planned this study aimed at investigating the presence of APA at 3rd year of TBI, and association between the TBI induced hypopituitarism and APA.

Patients and Design: Twenty nine patients who completed 3 years follow-up after TBI were included in the present study. APA and pituitary function were evaluated in all patients 3 years after TBI; moreover APA were tested also in sera of 60 age/sex matched normal controls. APA were investigated by an indirect immunofluorescence method.

Results: APA were detected in 13 of 29 TBI patients (44.8%) but in none of normal controls. Pituitary dysfunction development ratio was significantly higher in APA positive patients (46.2 %) when compared with APA negative ones (12.5 %) (p=0.04). There was a significant association between APA positivity and hypopituitarism due to TBI (odds ratio: 2.25,95% CI 1.1-4.6).

Conclusions: This study shows for the first time the presence of APA in TBI patients three years after head trauma. Moreover present investigation indicates preliminary evidence that APA may be associated with the development of TBI induced pituitary dysfunction, thus suggesting that autoimmunity may contribute in the development of TBI-induced hypopituitarism.