Auto-immunity of the Anterior Pituitary

Abstract

Since the endocrine organs seem unduly susceptible to auto-immune disorders, one might have expected that the anterior pituitary would not be excluded from such lesions. This has indeed been the case, although auto-immune hypophysitis has (so far) appeared to be a rare disorder. Lymphoid involvement of the pituitary was observed as early as 1953, but auto-immune processes were not suspected (Rapp and Pashkis 1953). The first patient in whom there was a suspicion of this condition was reported by Goudie and Pinkerton (1962); they described a young woman, aged 22, who died of a peripheral vascular collapse following removal of a gangrenous appendix. She had felt fatigued following the birth of a second child 14 months previously, and had had only two scanty menstrual periods between that time and her subsequent death. She also had been found to have an enlarging goitre, and had been treated with thyroid therapy. At autopsy, her very large goitre was proven to result from Hashimoto’s thyroiditis. A shrunken anterior pituitary gland was discovered; histology of the latter showed extensive lymphocytic infiltration of the anterior pituitary surrounding atrophic pituitary cells. Goudie and Pinkerton proposed that the coexistence of the lymphocytic hypophysitis and Hashimoto’s thyroiditis might well be explained by an auto-immune mechanism. Goudie (1968) again discussed this proposal.