Association of Addison's disease with autoimmune disorders—a long-term observation of 180 patients

Kasperlik-Załuska, A; Migdalska, B; Czarnocka, Barbara; Drac-Kaniewska, J; E, Niegowska; Czech, W

doi:10.1136/pgmj.67.793.984

Cited by 45 publications

(42 citation statements)

References 9 publications

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“…Similar to previous studies, females prevailed among AAD patients in the current cohort, and, intriguingly, their age at disease onset was significantly higher than in males [10][11][12][13][14]. The latter observation seems to be a consistent finding in AAD, however, no plausible explanation has been proposed to date.…”

Section: Discussionsupporting

confidence: 87%

Screening for associated autoimmune disorders in Polish patients with Addison’s disease

Fichna

Gryczyńska

et al. 2010

Endocr

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Autoimmune Addison's disease (AAD) is the main reason of primary adrenal failure. More than a half of patients display additional autoimmune conditions, which represent a considerable clinical concern. This study aimed to investigate the prevalence of concomitant autoimmune disorders in 85 Polish AAD patients (61 females, 24 males). Mean age at AAD onset was 34.6 ± 12.6 years, significantly earlier in males (P < 0.001). Sixty-nine patients presented positive serum antibodies to 21-hydroxylase and shorter AAD duration than those with negative results (P = 0.027). Seventy-three subjects suffered from coexisting autoimmune disorders. Serum autoantibodies against thyreoperoxidase, thyroglobulin, TSH receptor, glutamic acid decarboxylase, insulin, tyrosine phosphatase-like protein IA2, parietal cell H(+)/K(+)-ATPase, intrinsic factor and tissue transglutaminase were detectable in 71.8, 41.2, 4.7, 21.0, 4.9, 2.5, 49.4, 12.0 and 3.5% of patients, respectively. Antinuclear antibodies were found in 12.5%. Thyroid autoimmunity was most common (46 subjects with lymphocytic thyroiditis, 19 with Graves' disease), followed by atrophic gastritis (29.4%), pernicious anaemia (11.8%), hypergonadotropic hypogonadism (8.2%), vitiligo (8.2%), type 1 diabetes (7.1%), celiac disease (3.5%) and alopecia (2.4%). Gender differences were observed only for thyroid autoimmunity. Current study confirms particular tendency of AAD patients to develop other autoimmune disorders. Active search for concomitant conditions is warranted to prevent serious complications.

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Section: Discussionsupporting

confidence: 87%

Screening for associated autoimmune disorders in Polish patients with Addison’s disease

Fichna

Gryczyńska

et al. 2010

Endocr

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“…Given the frequent association of AD with other autoimmune diseases (2,(13)(14)(15), the identification of subjects with an ongoing autoimmune AD is especially important in clinical management of endocrine autoimmune diseases such as Hashimoto's thyroiditis, Graves' disease, type 1 diabetes mellitus (IDDM) and premature ovarian failure (POF). 21OHAb can be found in 3% of Graves' disease and in up to 2% of IDDM patients (11,16).…”

Section: Introductionmentioning

confidence: 99%

Autoantibodies against recombinant human steroidogenic enzymes 21-hydroxylase, side-chain cleavage and 17alpha-hydroxylase in Addison's disease and autoimmune polyendocrine syndrome type III

Silva

Kater

Dib

et al. 2000

European Journal of Endocrinology

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Objective: To evaluate the frequency of autoantibodies (Ab) against 21 hydroxylase (21OH), side-chain cleavage (SCC) and 17a-hydroxylase (17OH), in Addison's disease (AD) and autoimmune polyendocrine syndrome type III (APSIII). Design and Methods: We used radiobinding assays and in vitro translated recombinant human 35 S-21OH, 35 S-SCC or 35 S-17OH and studied serum samples from 29 AD (18 idiopathic, 11 granulomatous) and 18 APSIII (autoimmune thyroid disease plus type 1 diabetes mellitus, without AD) patients. Results were compared with those of adrenocortical autoantibodies obtained with indirect immunofluorescence (ACA-IIF). Results: ACA-IIF were detected in 15/18 (83%) idiopathic and in 1/11 (9%) granulomatous AD subjects. 21OHAb were found in 14/18 (78%) idiopathic and in the same (9%) granulomatous AD subject. A significant positive correlation was shown between ACA-IIF and 21OHAb levels (r 2 ¼ 0.56, P < 0.02). The concordance rate between the two assays was 83% (24/29) in AD patients. SCCAb were found in 5/18 (28%) idiopathic (4 of whom were also positive for 21OHAb) and in the same (9%) granulomatous AD subject. 17OHAb were found in only 2/18 (11%) idiopathic and none of the granulomatous AD patients. Two APSIII patients were positive for ACA-IIF, but only one was positive for 21OHAb and SCCAb. 17OHAb were found in another two APSIII patients. Conclusions: Measurement of 21OHAb should be the first step in immune assessment of patients with AD and individuals at risk for adrenal autoimmunity, in addition to ACA-IIF. Due to their low prevalence in AD, measurement of SCCAb and 17OHAb should be indicated only for 21OHAb negative patients and/or for those with premature ovarian failure, regardless of ACA-IIF results.

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“…Adrenal tuberculosis usually presents with adrenal insufficiency and is the cause of around 20% of cases worldwide. Other causes include autoimmune, other infectious diseases primarily meningococcal meningitis, replacement by metastatic cancer or lymphoma, adrenal hemorrhage or infarction, or drugs [6,7]. Adrenal hemorrhage is usually rarer than adrenal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

A Case of Unilateral Adrenal Hemorrhage in Pulmonary Tuberculosis Presenting as Acute Abdominal Pain

Nadkarni¹

2012

J Med Cases

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A 75-year-old male presented with productive cough; unintentional weight loss and constitutional symptoms since 1 month and was diagnosed with pulmonary tuberculosis. He was then started on appropriate antitubercular therapy. During his hospitalization, he developed acute abdominal pain. Laboratory testing was consistent with acute adrenal insufficiency and was diagnosed to be acute adrenal insufficiency secondary to unilateral hemorrhage on a computerized tomography scan. He was treated with corticosteroids and had recovery of adrenal function. Through this case, we wish to illustrate the importance of recognizing early this rare but potentially life threatening complication of pulmonary tuberculosis.

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Association of Addison's disease with autoimmune disorders—a long-term observation of 180 patients

Cited by 45 publications

References 9 publications

Screening for associated autoimmune disorders in Polish patients with Addison’s disease

Screening for associated autoimmune disorders in Polish patients with Addison’s disease

Autoantibodies against recombinant human steroidogenic enzymes 21-hydroxylase, side-chain cleavage and 17alpha-hydroxylase in Addison's disease and autoimmune polyendocrine syndrome type III

A Case of Unilateral Adrenal Hemorrhage in Pulmonary Tuberculosis Presenting as Acute Abdominal Pain

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