Pituitary and systemic autoimmunity in a case of intrasellar germinoma

Germinomas arising in the sella turcica are difficult to differentiate from autoimmune hypophysitis because of similar clinical and pathological features. This differentiation, nevertheless, is critical for patient care due to different treatments of the two diseases. We report the case of an 11-yea...

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Main Authors:	Gutenberg, Angelika, Bell, Jennifer J., Lupi, Isabella, Tzou, Shey-Cherng, Landek-Salgado, Melissa A., Kimura, Hiroaki, Su, Jack, Karaviti, Lefkothea P., Salvatori, Roberto, Caturegli, Patrizio
Format:	Online
Language:	English
Published:	Springer US 2009
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291822/

id	pubmed-3291822
recordtype	oai_dc
spelling	pubmed-32918222012-03-21 Pituitary and systemic autoimmunity in a case of intrasellar germinoma Gutenberg, Angelika Bell, Jennifer J. Lupi, Isabella Tzou, Shey-Cherng Landek-Salgado, Melissa A. Kimura, Hiroaki Su, Jack Karaviti, Lefkothea P. Salvatori, Roberto Caturegli, Patrizio Article Germinomas arising in the sella turcica are difficult to differentiate from autoimmune hypophysitis because of similar clinical and pathological features. This differentiation, nevertheless, is critical for patient care due to different treatments of the two diseases. We report the case of an 11-year-old girl who presented with diabetes insipidus and growth retardation, and was found to have an intra- and supra-sellar mass. Initial examination of the pituitary biopsy showed diffuse lymphocytic infiltration of the adenohypophysis and absent placental alkaline phosphatase expression, leading to a diagnosis of hypophysitis and glucocorticoid treatment. Because of the lack of clinical and radiological response, the pituitary specimen was re-examined, revealing this time the presence of scattered c-kit and Oct4 positive germinoma cells. The revised diagnosis prompted the initiation of radiotherapy, which induced disappearance of the pituitary mass. Immunological studies showed that the patient’s serum recognized antigens expressed by the patient’s own germinoma cells, as well as pituitary antigens like growth hormone and systemic antigens like the Sjögren syndrome antigen B and alpha-enolase. The study first reports the presence of pituitary and systemic antibodies in a patient with intrasellar germinoma, and reminds us that diffuse lymphocytic infiltration of the pituitary gland and pituitary antibodies does not always indicate a diagnosis of autoimmune hypophysitis. Springer US 2009-05-26 2011-12 /pmc/articles/PMC3291822/ /pubmed/19466616 http://dx.doi.org/10.1007/s11102-009-0187-x Text en © Springer Science+Business Media, LLC 2009
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Gutenberg, Angelika Bell, Jennifer J. Lupi, Isabella Tzou, Shey-Cherng Landek-Salgado, Melissa A. Kimura, Hiroaki Su, Jack Karaviti, Lefkothea P. Salvatori, Roberto Caturegli, Patrizio
spellingShingle	Gutenberg, Angelika Bell, Jennifer J. Lupi, Isabella Tzou, Shey-Cherng Landek-Salgado, Melissa A. Kimura, Hiroaki Su, Jack Karaviti, Lefkothea P. Salvatori, Roberto Caturegli, Patrizio Pituitary and systemic autoimmunity in a case of intrasellar germinoma
author_facet	Gutenberg, Angelika Bell, Jennifer J. Lupi, Isabella Tzou, Shey-Cherng Landek-Salgado, Melissa A. Kimura, Hiroaki Su, Jack Karaviti, Lefkothea P. Salvatori, Roberto Caturegli, Patrizio
author_sort	Gutenberg, Angelika
title	Pituitary and systemic autoimmunity in a case of intrasellar germinoma
title_short	Pituitary and systemic autoimmunity in a case of intrasellar germinoma
title_full	Pituitary and systemic autoimmunity in a case of intrasellar germinoma
title_fullStr	Pituitary and systemic autoimmunity in a case of intrasellar germinoma
title_full_unstemmed	Pituitary and systemic autoimmunity in a case of intrasellar germinoma
title_sort	pituitary and systemic autoimmunity in a case of intrasellar germinoma
description	Germinomas arising in the sella turcica are difficult to differentiate from autoimmune hypophysitis because of similar clinical and pathological features. This differentiation, nevertheless, is critical for patient care due to different treatments of the two diseases. We report the case of an 11-year-old girl who presented with diabetes insipidus and growth retardation, and was found to have an intra- and supra-sellar mass. Initial examination of the pituitary biopsy showed diffuse lymphocytic infiltration of the adenohypophysis and absent placental alkaline phosphatase expression, leading to a diagnosis of hypophysitis and glucocorticoid treatment. Because of the lack of clinical and radiological response, the pituitary specimen was re-examined, revealing this time the presence of scattered c-kit and Oct4 positive germinoma cells. The revised diagnosis prompted the initiation of radiotherapy, which induced disappearance of the pituitary mass. Immunological studies showed that the patient’s serum recognized antigens expressed by the patient’s own germinoma cells, as well as pituitary antigens like growth hormone and systemic antigens like the Sjögren syndrome antigen B and alpha-enolase. The study first reports the presence of pituitary and systemic antibodies in a patient with intrasellar germinoma, and reminds us that diffuse lymphocytic infiltration of the pituitary gland and pituitary antibodies does not always indicate a diagnosis of autoimmune hypophysitis.
publisher	Springer US
publishDate	2009
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291822/
_version_	1611509841765859328

Pituitary and systemic autoimmunity in a case of intrasellar germinoma

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