ACE IgG4 APA levels for diagnosing hypophysitis

How useful are serum ACE, IgG4, and antipituitary antibody (APA) levels for diagnosing hypophysitis?

  • Sarcoidosis and IgG4-related diseases generally require a tissue sample for diagnosis. A serum or CSF ACE level is a highly specific (95%), but insensitive (25%–76%) marker for neurosarcoidosis.
  • Similarly, for IgG4 hypophysitis, elevated serum/CSF concentrations of IgG4 are found in only ≈ 70% of patients. Lastly, investigations of APAs and antihypothalamus antibodies have been studied, but these tests currently have insufficient sensitivities and specificities for diagnostic utility.
  • In general, the diagnosis of hypophysitis is difficult as no preoperative laboratory test currently exists.
  • In most cases, the diagnosis is suspected/presumed, and definitive diagnosis of hypophysitis, particularly if indicated by progressive disease, is determined through histologic examination of biopsied tissue.

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