Vol 70, No 2 (2019)
Original paper
Published online: 2019-01-16

open access

Page views 2918
Article views/downloads 2154
Get Citation

Connect on Social Media

Connect on Social Media

Pernicious anaemia and endocrine glands antibodies

Elżbieta Morawiec-Szymonik1, Wanda Foltyn2, Bogdan Marek2, Beata Kos-Kudła2, Dariusz Kajdaniuk2
Pubmed: 30648728
Endokrynol Pol 2019;70(2):143-150.


Introduction: The aim of the study was to determine the frequency of occurrence of antibodies participating in the development of endocrine diseases in patients with autoimmune haematopoietic disease, thus documenting the potential suitability of specific diagnostic and screening tests.

Material and methods: The study group consisted of 124 persons (men and women) with newly diagnosed pernicious anaemia (PA) and a control group (C) of 41 healthy people. Antibodies against: intrinsic factor (IFAb), gastric parietal cells (APCA), thyroid peroxidase (TPOAb), thyroglobulin (TgAb), adrenal cortex (AdrenalAb), and pituitary anterior lobe (PituitaryAb) were determined in the blood.


1. The risk of the presence of antibodies against endocrine glands in patients with PA can be classified in order: TPOAb and/or TgAb — 41.1%, TPOAb — 36.3%, TgAb — 25.0%, TPOAb and TgAb — 20.2%, AdrenalAb — 1.6%, PituitaryAb — 0.8%.

2. TPOAb and/or TgAb (mainly TPOAb) are more frequently present in patients with PA, who have IFAb and/or APCA. This correlation is most evident in patients with simultaneous occurrence of IFAb and APCA.

3. Among patients with PA, the simultaneous presence of antibodies IFAb and/or APCA with TPOAb and/or TgAb antibodies is most likely in women over 45 years of age. 4. In group C, 12% had at least one of two antithyroid antibodies (TgAb twice as often as TPOAb), and 2.4% had both. AdrenalAb and PituitaryAb are not found in healthy persons.

Conclusions: In patients with PA, a screening for autoimmune thyroid disease is justified, which should first involve the determination of TPOAb (further TgAb) in the blood. The assessment of antithyroid antibodies should be recommended primarily to patients with PA, who have IFAb and/or APCA, and in particular those with concurrent IFAb and APCA.

Article available in PDF format

View PDF Download PDF file


  1. Quincke H, Gunn J. Abstract of a Lecture on Pernicious Anæmia. Edinb Med J. 1877; 22(12): 1087–1098.
  2. Schwartz M, Schwartz M, Schwartz M, et al. Antibody to intrinsic factor. Scand J Clin Lab Invest Suppl. 1967; 95: 19–27.
  3. Toh BH, Alderuccio F. Pernicious Anaemia. Autoimmunity. 2009; 37(4): 357–361.
  4. Andres E, Serraj K. Optimal management of pernicious anemia. J Blood Med. 2012; 3: 97–103.
  5. Park JY, Lam-Himlin D, Vemulapalli R. Review of autoimmune metaplastic atrophic gastritis. Gastrointest Endosc. 2013; 77(2): 284–292.
  6. Song IC, Lee HJ, Kim HJ, et al. A multicenter retrospective analysis of the clinical features of pernicious anemia in a Korean population. J Korean Med Sci. 2013; 28(2): 200–204.
  7. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013; 368(2): 149–160.
  8. Bizzaro N, Antico A. Diagnosis and classification of pernicious anemia. Autoimmun Rev. 2014; 13(4–5): 565–568.
  9. Toh BH. Diagnosis and classification of autoimmune gastritis. Autoimmun Rev. . 2014; 13(4–5): 459–462.
  10. Murphy G, Dawsey SM, Engels EA, et al. Cancer Risk After Pernicious Anemia in the US Elderly Population. Clin Gastroenterol Hepatol. 2015; 13(13): 2282–9.e1.
  11. Rojas Hernandez CM, Oo TH. Advances in mechanisms, diagnosis, and treatment of pernicious anemia. Discov Med. 2015; 19(104): 159–168.
  12. Watanabe S, Ide N, Ogawara H, et al. High percentage of regulatory T cells before and after vitamin B12 treatment in patients with pernicious anemia. Acta Haematol. 2015; 133(1): 83–88.
  13. Rusak E, Chobot A, Krzywicka A, et al. Anti-parietal cell antibodies — diagnostic significance. Adv Med Sci. 2016; 61(2): 175–179.
  14. Hughes JW, Muegge BD, Tobin GS, et al. High-risk gastric pathology and prevalent autoimmune diseases in patients with pernicious anemia. Endocr Pract. 2017; 23(11): 1297–1303.
  15. Lipiński M, Rydzewska G, Foltyn W, et al. Gastroduodenal neuroendocrine neoplasms, including gastrinoma — management guidelines (recommended by the Polish Network of Neuroendocrine Tumours). Endokrynol Pol. 2017; 68(2): 138–153.
  16. Nagao T, Hirokawa M. Diagnosis and treatment of macrocytic anemias in adults. J Gen Fam Med. 2017; 18(5): 200–204.
  17. Markson JL, Moore JM. Thyroid Auto-antibodies in Pernicious Anaemia. Br Med J. 1962; 2(5316): 1352–1355.
  18. Toh BH, van Driel IR, Gleeson PA. Pernicious anemia. N Engl J Med. 1997; 337(20): 1441–1448.
  19. Fernando MM, Stevens CR, Walsh EC, et al. Defining the role of the MHC in autoimmunity: a review and pooled analysis. PLoS Genet. 2008; 4(4): e1000024.
  20. Nass FR, Kotze LM, Nisihara RM, et al. Autoantibodies in relatives of celiac disease patients: a follow-up of 6–10 years. Arq Gastroenterol. 2012; 49(3): 199–203.
  21. Tozzoli R, Kodermaz G, Perosa AR, et al. Autoantibodies to parietal cells as predictors of atrophic body gastritis: a five-year prospective study in patients with autoimmune thyroid diseases. Autoimmun Rev. 2010; 10(2): 80–83.
  22. Banka S, Ryan K, Thomson W, et al. Pernicious anemia — genetic insights. Autoimmun Rev. 2011; 10(8): 455–459.
  23. Cellini M, Santaguida MG, Virili C, et al. Hashimoto's Thyroiditis and Autoimmune Gastritis. Front Endocrinol (Lausanne). 2017; 8: 92.
  24. Tokić S, Štefanić M, Karner I, et al. Altered expression of CTLA-4, CD28, VDR, and CD45 mRNA in T cells of patients with Hashimoto's thyroiditis — a pilot study. Endokrynol Pol. 2017; 68(3): 274–828.
  25. Zulfiqar AA, Andres E. Association pernicious anemia and autoimmune polyendocrinopathy: a retrospective study. J Med Life. 2017; 10(4): 250–253.
  26. Zauli D, Tosti A, Biasco G, et al. Prevalence of autoimmune atrophic gastritis in vitiligo. Digestion. 1986; 34(3): 169–172.
  27. Davidson RJ, Atrah HI, Sewell HF. Longitudinal study of circulating gastric antibodies in pernicious anaemia. J Clin Pathol. 1989; 42(10): 1092–1095.
  28. Carmel R. Reassessment of the relative prevalences of antibodies to gastric parietal cell and to intrinsic factor in patients with pernicious anaemia: influence of patient age and race. Clin Exp Immunol. 1992; 89(1): 74–77.
  29. Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood. 2008; 112(6): 2214–2221.
  30. De Bellis A, Bizzarro A, Conte M, et al. Antipituitary antibodies in adults with apparently idiopathic growth hormone deficiency and in adults with autoimmune endocrine diseases. J Clin Endocrinol Metab. 2003; 88(2): 650–654.
  31. Bellastella G, Rotondi M, Pane E, et al. Italian Autoimmune Hypophysitis Network Study. Predictive role of the immunostaining pattern of immunofluorescence and the titers of antipituitary antibodies at presentation for the occurrence of autoimmune hypopituitarism in patients with autoimmune polyendocrine syndromes over a five-year follow-up. J Clin Endocrinol Metab. 2010; 95(8): 3750–3757.
  32. Guaraldi F, Caturegli P, Salvatori R. Prevalence of antipituitary antibodies in acromegaly. Pituitary. 2012; 15(4): 490–494.
  33. Ricciuti A, De Remigis A, Landek-Salgado MA, et al. Detection of pituitary antibodies by immunofluorescence: approach and results in patients with pituitary diseases. J Clin Endocrinol Metab. 2014; 99(5): 1758–1766.
  34. Chan JC, Liu HS, Kho BC, et al. Pattern of thyroid autoimmunity in chinese patients with pernicious anemia. Am J Med Sci. 2009; 337(6): 432–437.
  35. Velarde-Mayol C, de la Hoz-García B, del Cañizo-Fernández-Roldán C, et al. [Pernicious anemia and autoimmune thyroid diseases in elderly people]. Rev Esp Geriatr Gerontol. 2015; 50(3): 126–128.
  36. Morel S, Georges A, Bordenave L, et al. Thyroid and gastric autoimmune diseases. Ann Endocrinol (Paris). 2009; 70(1): 55–58.
  37. Fichna M, Fichna P, Gryczyńska M. Screening for associated autoimmune disorders in Polish patients with Addison's disease. Endocrine. 2010; 37(2): 349–360.
  38. Castoro C, Le Moli R, Arpi ML, et al. Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: experience from a single institution. J Endocrinol Invest. 2016; 39(7): 779–784.
  39. Cicone F, Papa A, Lauri C, et al. Thyro-gastric autoimmunity in patients with differentiated thyroid cancer: a prospective study. Endocrine. 2015; 49(1): 163–169.