title: Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects.
abstract: OBJECTIVE
  This publication reviews the accepted knowledges and the findings still discussed on several features of autoimmune hypophysitis, including the most recently described forms, such as IgG4 and cancer immunotherapy- related hypophysitis.
  
  
  METHODS
  The most characteristic findings and the pending controversies were derived from a literature review and previous personal experiences. A single paragraph focused on some atypical examples of the disease presenting under confounding pretences.
  
  
  RESULTS
  Headache, visual field alterations and impaired pituitary secretion are the most frequent clinical findings of the disease. Pituitary biopsy, still considered the gold diagnostic standard, does not always receive consent from the patients. The role of magnetic resonance imaging is limited, as this disease may generate images similar to those of other diseases. The role of antipituitary and antihypothalamus antibodies is still discussed owing to methodological difficulties and also because the findings on the true pituitary antigen(s) are still debated. However, the low sensitivity and specificity of immunofluorescence, one of the more widely employed methods to detect these antibodies, may be improved, considering a predetermined cut-off titre and a particular kind of immunostaining.
  
  
  CONCLUSIONS
  Autoimmune hypophysitis is a multifaceted disease, which may certainly be diagnosed by pituitary biopsy. However, the possible different clinical, laboratory and imaging features must be considered by the physician to avoid a misdiagnosis when examining a possibly affected patient. Therapeutic choice has to be made taking into account the clinical conditions and the degree of hypothalamic-pituitary involvement, but also considering that spontaneous remissions can occur.
authors: Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors: Giuseppe
authors: G
authors: Bellastella
authors: Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors: Maria Ida
authors: MI
authors: Maiorino
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Antonio
authors: A
authors: Bizzarro
authors: Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors: Dario
authors: D
authors: Giugliano
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Katherine
authors: K
authors: Esposito
authors: Endocrinology and Metabolic Diseases Unit, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy. antonio.bellastella@unina2.it.
authors: Antonio
authors: A
authors: Bellastella
authors: Endocrinology and Metabolic Diseases Unit, Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy.
authors: Annamaria
authors: A
authors: De Bellis
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000069281:Autoimmune Hypophysitis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D060908:CTLA-4 Antigen / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics; D006801:Humans; D007074:Immunoglobulin G; D010902:Pituitary Gland / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D060908:CTLA-4 Antigen; D006680:HLA Antigens; D007074:Immunoglobulin G
keywords: Antipituitary antibodies; Autoimmune hypophysitis; IgG4 plasmacytic hypophysitis; Lymphocytic hypophysitis