Background: In vitro and animal experiments have clearly demonstrated that excessive cortisol, GH and prolactin secretion, as well as dopamine agonists (D2As) and somatostatin analogs (SSAs), often prescribed for their treatment, affect the immune response and the onset/evolution of autoimmune diseases (AIDs) through direct and indirect complex mechanisms. Data from clinical studies are very scanty.
Study aim: To assess the 1) distribution of AIDs according to patient age and gender, adenoma and AID type; and 2) evolution of AID(s) with respect to hormonal activity and eventual DA/SSA treatment, in patients with Cushings disease (CD), acromegaly and prolactinoma with respect to patients with non-functioning adenoma (NFPA; controls).
Patients and methods: Clinical data of interest were collected retrospectively and prospectively from patient records and a purposely designed questionnaire.
Results: 715 patients. 144 with CD (118 F; previous treatment:144 endoscopic surgery (ES), 12 radiation therapy (RT), 18 adrenalectomy, 42 medical therapy (MT); 120 under remission, 24 active disease under treatment); 124 with acromegaly (75 F; previous treatment: 100 ES, 25 RT, 60 medical therapy; 81 remission, 43 active disease under treatment); 260 with prolactinoma (162 F; previous treatment: 29 ES, 4 RT, 251 medical therapy; 177 remission, 83 active disease under treatment) and 187 NFPA (101 F; previous treatment: 170 ES and 17 RT). Age at evaluation was similar among groups. Patients with AID were 39 (27.1%) in CD, 23 (18.5%) in acromegaly, 52 (21%) in prolactinoma, and 17 (9%) in NFPA group. CD was associated with the highest risk of developing AIDs (χ2=8.42, P<0.0001); prevalence in acromegaly and prolactinoma was similar and higher than in NFPAs (P<0.0001). In all groups, females were typically affected (P=0.001). AID type, gender and age distribution were similar to the general population. Almost all patients presented a single AID. Hashimotos thyroiditis was the most common (P<0.001), followed by psoriasis and rheumatoid arthritis. AIDs diagnosed before CD (n=24) typically improved during overt hypercortisolism and recurred after CD remission, except for Hashimotos thyroiditis (independent evolution). New onset/recrudescence of AIDs (n=13) occurred from some weeks to some years after CD remission (median 1 year). AIDs similarly occurred before and after prolactinoma diagnosis; in acromegaly they mainly occurred during active disease (P>0.01); for both groups AID evolution was independent from hormone control and SSA/D2A treatment.
Conclusions: Patients with pituitary adenomas, especially females with CD, deserve careful and repeated evaluation of AIP during follow-up, independently from adenoma size and treatment.
21 May 2022 - 24 May 2022