53%) healthy controls. TSGA10 autoantibodies were not detected in the serum from patients with any other autoimmune disease. Autoantibodies against TSGA10 were detectable from a young age in 4/5 positive Rapamycin datasheet APS1 patients with autoantibody titres remaining relatively constant over time. Furthermore, real-time PCR confirmed TSGA10 mRNA to be most abundantly expressed in the testis and also showed moderate and low expression

levels throughout the entire body. TSGA10 should be considered as an autoantigen in a subset of APS1 patients and also in a minority of SLE patients. No recognizable clinical phenotype could be found to correlate with positive autoantibody reactivity. Autoimmune polyendocrine syndrome type 1 (APS1; alternatively known as autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy, APECED) is a rare monogenic autoimmune disease resulting from mutations in the AIRE gene. The AIRE gene plays a vital role in the removal and inhibition of self-reactive T cells in the thymus [1–3], a breakdown of which consequently leads to the development of the organ-specific autoimmune disease APS1. The disorder is characterized by the classical triad of chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal failure, the presence of at least two of these are traditionally required for the diagnoses. These

components begin to manifest in the first decade of life, often followed by the progressive emergence of other organ-specific autoimmune diseases including gonadal failure, MK-2206 nmr intestinal dysfunction and insulin-dependent diabetes mellitus as well as ectodermal manifestations, all with variable penetrance. Pituitary manifestations are another lesser described component of APS1, being diagnosed in approximately 7% of all APS1 patients [4]. Patients present with single or multiple pituitary deficits, the most commonly reported deficit being isolated

growth hormone (GH) deficiency [5]. Partial adrenocorticotropin hormone deficiency, isolated hypogonadotrophic hypogonadism, central/idiopathic diabetes insipidus [5–11] and lymphocytic hypophysitis [12] have also been described. Pituitary autoantibodies in APS1 sera have been detected against both lactotrophs and CYTH4 gonadotrophs using immunohistochemistry [5, 13, 14]. APS1 patients also have autoantibodies directed towards a small number of guinea pig anterior pituitary cells, 40–50% of which are GH-producing cells [15]. In addition, a fibre-plexus staining pattern is observed in the pituitary intermediate lobe. Several of the major APS1 autoantigens previously identified are involved in monoamine and gamma-aminobutyric acid (GABA) synthesis and are expressed in pituitary tissue. APS1 patient sera target aromatic l-amino acid decarboxylase (AADC) and tyrosine hydroxylase (TH) in the anterior pituitary and glutamic acid decarboxylase 65 (GAD) in the intermediate lobe [13, 15], yet these do not account for the entire immunostaining seen.