Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review

Lee, Keum Hwa; Lee, Hyun Jeong; Lee, Cheol hun; Kim, Jin Yeong; Kim, Jong Min; Kim, Se Seung; Jeong, Sun Young; Hwang, In Sung; Kim, Nam‐Soo; Kim, Na Eun; Shin, Soogeun; Shin, Dongkwan; Song, J.; Shin, Dong Hyun; Kim, Jung Dong; Kim, Jeehoon; Lee, Yong Seok; Kang, Hyun Joo; Kim, Dong Ha; Moon, So Hyun; Rho, Won Suk; Lee, Joo Yeon; Kronbichler, Andreas; Shin, Jae Il

doi:10.1016/j.autrev.2018.06.014

Cited by 25 publications

(40 citation statements)

References 26 publications

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“…APS was present in 73% of cases, SLE in 17% of the patients, while 2% had a diagnosis of both SLE and APS. 23 Hemorrhage was the most frequently reported cause of adrenal insufficiency, which was observed in 36 patients (37.89%). Infarction and adrenal hematoma were observed in 19 (20%) and 7 (7.37%) patients, respectively.…”

Section: Haematological Involvement Recommendations and Overall Quality Of Evidencementioning

confidence: 99%

16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome

Sciascia

Radin

Cecchi

et al. 2021

Lupus

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The objectives of the 16th International Congress on Antiphospholipid Antibodies (aPL) Task Force on Clinical Manifestations of Antiphospholipid Syndrome (APS) were to critically analyze: a) the definition of “APS”; b) the current knowledge on non-traditional manifestations associated with aPL; and c) the risk stratification strategies in aPL-positive patients. The quality of evidence was assessed by the GRADE system. The task force concluded that: a) APS does not have a uniform definition given the heterogeneity of the clinical presentations and different aPL profiles; b) current literature supports the role for aPL testing in cases of thrombocytopenia and recurrent cardiac events but are limited by vast heterogeneity, providing an overall low-to-very low level of evidence; and c) risk stratification strategies in aPL-positive patients, such as aPL-Score and Global APS Score, can be useful in clinical practice. International multicenter studies are still highly needed to improve the quality of available evidence and consequently the strength of future recommendations.

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Section: Haematological Involvement Recommendations and Overall Quality Of Evidencementioning

confidence: 99%

16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome

Sciascia

Radin

Cecchi

et al. 2021

Lupus

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“…They require significant costs from the health care system when diagnosed at late stages: for example, the annual costs of treating one case of systemic lupus erythematosus (SLE) with renal or neuropsychiatric complications in the USA in 2013 exceeded 30,000-32,000 US $, being 6.25-6.5 times higher than the cost of treating the initial, inactive, and uncomplicated phases of the disease [6]. Early diagnosis of ADs is desirable, but the process often takes a long time, due to the absence of specific symptoms in early stages of these diseases in many patients [7][8][9][10]. This factor determines the relevance of the search for laboratory tests suitable for the early diagnosis and screening of ADs in order to timely prescribe appropriate treatment.…”

Section: Introductionmentioning

confidence: 99%

Antinuclear Autoantibodies in Health: Autoimmunity Is Not a Synonym of Autoimmune Disease

et al. 2021

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The incidence of autoimmune diseases is increasing. Antinuclear antibody (ANA) testing is a critical tool for their diagnosis. However, ANA prevalence in healthy persons has increased over the last decades, especially among young people. ANA in health occurs in low concentrations, with a prevalence up to 50% in some populations, which demands a cutoff revision. This review deals with the origin and probable physiological or compensatory function of ANA in health, according to the concept of immunological clearance, theory of autoimmune regulation of cell functions, and the concept of functional autoantibodies. Considering ANA titers ≤1:320 as a serological marker of autoimmune diseases seems inappropriate. The role of anti-DFS70/LEDGFp75 autoantibodies is highlighted as a possible anti-risk biomarker for autoimmune rheumatic disorders. ANA prevalence in health is different in various regions due to several underlying causes discussed in the review, all influencing additive combinations according to the concept of the mosaic of autoimmunity. Not only are titers, but also HEp-2 IFA) staining patterns, such as AC-2, important. Accepting autoantibodies as a kind of bioregulator, not only the upper, but also the lower borders of their normal range should be determined; not only their excess, but also a lack of them or “autoimmunodeficiency” could be the reason for disorders.

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“…In 18 patients (23%), APS was diagnosed before AI, in 46 patients (60%) APS and AI diagnosed at the same time, and in 13 patients (17%) APS was diagnosed after AI. 6 In a study by Espinosa et. al.…”

Section: Discussionmentioning

confidence: 98%

“…In the first mechanism, specific vascularization of the adrenal glands is responsible for the imbalance between a rich arterial supply and limited venous drainage, which leads to abrupt arterialcapillary network transition and causes venous thrombosis, followed by postinfarction hemorrhage. 6,10 In another important mechanism, high levels of membrane lysobisphosphatidic acid in zona fasciculate act as a target for antiphospholipid antibodies, leading to apoptosis and release of lysosomal proteinases, resulting in activated endothelial cells and microthrombosis. 10 In a study by Lee et.…”

Section: Discussionmentioning

confidence: 99%

Addison's disease in antiphospholipid syndrome: A rare complication

Yazdi

Shakibi

Mirkamali

et al. 2021

Clinical Case Reports

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Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review

Cited by 25 publications

References 26 publications

16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome

16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome

Antinuclear Autoantibodies in Health: Autoimmunity Is Not a Synonym of Autoimmune Disease

Addison's disease in antiphospholipid syndrome: A rare complication

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