title: Longitudinal behavior of autoimmune GH deficiency: from childhood to transition age.
abstract: BACKGROUND
  Some cases of apparently idiopathic GH deficiency (GHD) may be caused by pituitary autoimmunity.
  
  
  OBJECTIVE
  To study the variations in pituitary function and antipituitary antibodies (APA) from childhood to transition age in patients with apparently idiopathic GHD.
  
  
  METHODS
  We conducted a longitudinal study.
  
  
  METHODS
  Pituitary function and APA detection by immunofluorescence were investigated in 24 childhood patients with isolated GHD before starting recombinant GH therapy and after the stopping of this therapy in transition age. Sera of patients positive for APA were processed by double immunofluorescence to identify their pituitary target.
  
  
  RESULTS
  At diagnosis, 16 out of 24 patients were APA positive targeting only somatotrophs (group 1), while the remaining eight were APA negative (group 2). When retested off therapy, 12 out of 16 patients in group 1 persisted being APA positive, while the remaining four became negative with recovery of pituitary function. All patients in group 2 persisted being APA negative but still showing GHD. Of the 12 patients persistently APA positive, eight with confirmed GHD showed APA still targeting somatotrophs, whereas four showed APA targeting only gonadotrophs associated with isolated hypogonadotropic hypogonadism (HH).
  
  
  CONCLUSIONS
  Patients with APA at middle but not at high titer in childhood may show a remission of autoimmune GHD in childhood after GH replacement therapy. As APA may shift their target in transition period, an early characterization of APA by double immunofluorescence is advisable in APA positive GHD patients showing delayed puberty, to allow an early diagnosis and an appropriate therapy, thus preventing the progression toward HH.
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy annamaria.debellis@unina2.it.
authors.forename: Annamaria
authors.initials: A
authors.lastname: De Bellis
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellastella
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Maria Ida
authors.initials: MI
authors.lastname: Maiorino
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Aitella
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Emma
authors.initials: E
authors.lastname: Lucci
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Cozzolino
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellastella
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bizzarro
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Giugliano
authors.affiliation: Department of Cardiothoracic and Respiratory SciencesEndocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia 2, 80131 Napoli, ItalyDepartment of MedicalSurgical, Neurological, Metabolic and Geriatric Sciences, Endocrinology and Metabolic Diseases UnitDepartment of Clinical and Experimental MedicineSecond University of Naples, Napoli, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D001323:Autoantibodies / Q000276:immunology*; D000069281:Autoimmune Hypophysitis / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D002648:Child; D004393:Dwarfism, Pituitary / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D042341:Gonadal Hormones / Q000097:blood; D020249:Hormone Replacement Therapy / Q000379:methods; D019382:Human Growth Hormone / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008137:Longitudinal Studies; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D011388:Prolactin / Q000097:blood; D011994:Recombinant Proteins; D012074:Remission Induction; D012075:Remission, Spontaneous; D052683:Somatotrophs / Q000276:immunology*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D042341:Gonadal Hormones; D011994:Recombinant Proteins; D014284:Triiodothyronine; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone