• Failure of antibody response to polysaccharide antigen in treated panhypopituitary adults.

      Mukherjee, Annice; Helbert, M; Ryder, W David J; Borrow, R; Davis, Julian R E; Shalet, Stephen M; Department of Endocrinology, Christie Hospital, Manchester, UK. annice.mukherjee@srht.nhs.uk (2009-05)
      Although pituitary hormones are known to affect immune function, treated hypopituitarism is not a recognized cause of immune deficiency in humans. We set out to assess integrity of baseline and stimulated immune function in severely hypopituitary adults. Twenty-one panhypopituitary adults (group 1), on stable pituitary replacement including growth hormone, and 12 healthy volunteers (group 2) were studied. Lymphocyte subsets, pneumococcal antibody levels pre- and 1 month after polysaccharide vaccination, T cell numbers and in-vitro interferon (IFN)-gamma response were studied. There were no significant differences in T cell numbers or IFN-gamma secretion. B cell numbers were lower in group 1, especially those with low prolactin levels. Independent of this finding, nine of 21 patients in this group had low antibody response to polysaccharide antigen. This was most striking in those with low insulin-like growth factor 1 levels and appeared to be independent of the use of anti-convulsants or corticosteroid replacement. Significant humoral immune deficiency is seen in panhypopituitarism and may contribute to morbidity.
    • Immune function in hypopituitarism; time to reconsider?

      Mukherjee, Annice; Helbert, M; Davis, J R E; Shalet, Stephen M; Dept of Endocrinology, Christie Hospital, Manchester, UK. (2009-12-18)
      Abstract Hypopituitarism is not currently considered as a potential cause of immune disruption in humans. Accumulating data from in-vitro and animal models support a role for the pituitary gland in immune regulation. Furthermore the increased mortality risk noted in patients with adult hypopituitarism remains poorly explained and immune dysfunction could conceivably contribute to this observation. In a recent issue of Clinical & Experimental Immunology we presented new data relating to immune status in adults with treated, severe hypopituitarism. We observed humoral immune deficiency in a significant proportion, despite stable pituitary replacement, including growth hormone (GH). This was especially evident in those with low pre-treatment IGF-I levels and appeared independent of anticonvulsant use or corticosteroid replacement. These observations require substantiation with future studies. In this short review we summarise existing data relating to the effects of pituitary hormones on immune function, and discuss potential clinical implications surrounding the hypothesis of immune dysregulation in severe hypopituitarism.