High Prevalence of Thyroid Autoimmunity in Idiopathic Addison's Disease

Kasperlik-Załuska, A; Czarnocka, Barbara; Czech, W

doi:10.3109/08916939409007998

Cited by 22 publications

(16 citation statements)

References 11 publications

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“…It is widely recognised that iodine enrichment of the diet could trigger autoimmune thyroiditis in genetically prone individuals, such as AAD patients, for instance [20]. However, former report from another Polish AAD cohort also demonstrated comparable proportion of aTPO and aTg-positive individuals [21]. In both series, the disease was more frequent among females, similar to what is observed in the general population [19,22].…”

Section: Discussionsupporting

confidence: 77%

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: 77%

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

Fichna

Gryczyńska

et al. 2010

Endocr

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“…Variable occurrence of autoimmune thyroid disease (ATD) in patients with primary adrenal insufficiency (PAI) has been reported: 24% of 148 patients with Addison's disease in Poland [1], 47% of 664 patients in Norway [2], and 10 of 3,286 patients (0.3%) in the United Kingdom [3]. In contrast, less than 20 cases of comorbid PAI with ATD have been found in the English literature: 3 ATD patients with elevated plasma adrenocorticotropic hormone (ACTH) levels were proven to have subclinical PAI by a provocation test [4,5], and several ATD patients preliminarily screened by antiadrenal autoantibody tests were shown to have PAI by a provocation test [6,7].…”

Section: Introductionmentioning

confidence: 99%

Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease

Yamamoto¹

2015

Eur Thyroid J

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Background: Autoimmune thyroid disease (ATD) has been occasionally observed in patients with primary adrenal insufficiency (PAI). In contrast, less than 20 cases of comorbid PAI with ATD have been found in the English literature. One conceivable reason is difficulty in detecting latent PAI. Objective: Information of clinical presentation and diagnostics is sought to facilitate diagnosis of latent PAI. Methods: Latent PAI was pursued in 11 patients among 159 ATD patients. All of them were maintained in a euthyroid state. Except for one patient with nonrheumatic musculoskeletal symptoms, the other patients, who were asymptomatic in their daily lives, presented with recurrent nonspecific gastrointestinal symptoms or fatigue in stress-associated circumstances. Morning cortisol level <303 nmol/l was used as an inclusion criterion. Their basal adrenocorticotropic hormone levels were normal. The adrenal status was examined by a provocation test, either an insulin-induced hypoglycemia test or a 1-μg intravenous corticotrophin test. Eleven patients showed subnormal cortisol response. They were supplemented with hydrocortisone of doses ≤15 mg/day. After a few months of supplementation, PAI was confirmed by another provocation test. Three patients were excluded because of dissociation of two provocation tests. Results: Comorbid latent PAI with ATD was pursued from the symptoms stated above and proven by two provocation tests; it was found in 5% (8/159) of the patients. Conclusion: When patients with ATD are troubled by recurrent stress-associated gastrointestinal or constitutional symptoms or nonrheumatic musculoskeletal symptoms which have remained unrelieved by adjustment of thyroid medication, these symptoms may be a manifestation of comorbid latent PAI. It is worth investigating such patients for latent PAI.

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“…The incidence of thyrotoxicosis in patients with Addison's disease in about 5% which is nearly 10 times when compared to the general population [8]. There are a few case reports of thyrotoxicosis not being recognized initially in patients with primary adrenal insufficiency when both clinical conditions present simultaneously or vice versa [9,10] The mechanism of adrenal crisis in the setting of thyrotoxicosis is mainly related to increased rate of cortisol metabolism due to increased hepatic 4, 5-reductase activity.…”

Section: Discussion: Adrenal Insufficiencymentioning

confidence: 99%

“…At the time of admission to our hospital her random serum cortisol was of 0.71µg/dl (normal 5-27µg/dl) and plasma ACTH of 560 pg/ml (Normal 0-46pg/ml). The investigations for thyroid status showed TSH -0.004µIU/ml (normal: 0.3-4.5), T4 -30 µg% (8)(9)(10)(11)(12), and FT4 -6.82 ng% (0.8-1.8) which was suggestive of thyrotoxicosis. Her thyroid receptor antibody (TSI) level was 8.1 µ/L (Normal 1-5), anti-peroxidase autoantibody (anti -TPO) was 514 IU/ml (<50) by ELISA.…”

mentioning

confidence: 99%

Delayed Diagnosis of Graves’ Thyrotoxicoisis Presenting as Recurrent Adrenal Crisis in Primary Adrenal Insufficiency

Naik

Jebasingh

Thomas

2016

JCDR

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A 42-year-old female diagnosed with primary adrenal insufficiency, 2 years prior in another institution, was referred to the department of Endocrinology for the persistence of tiredness, weakness, giddiness and progressive weight loss. She was being previously evaluated for symptoms of vomiting, abdominal pain and refractory hypotension. Her blood investigations then had showed a random serum cortisol of 2 µg/dl dl, (Normal 5-27µg/dl ), serum sodium of 123 mEq/L(135-145), potassium of 5.6mEq/L (3.5-5) and plasma ACTH of 345 pg/ml (0-45 ),all were suggestive of primary adrenal insufficiency. Her Chest X ray, CT abdomen with contrast and thyroid function were all within normal limits during the time of initial admission. Thus final diagnosis of primary adrenal insufficiency with adrenal crisis was considered and was initially treated with intravenous hydrocortisone followed by twice daily dose of 5mg oral prednisolone. She was apparently asymptomatic for 1 and ½ years from the time of her initial diagnosis of primary adrenal insufficiency. Six months prior to an episode of of an adrenal crisis the patient noticed symptoms of fatigue, weakness, weight loss, giddiness and increasing hyper pigmentation. She was admitted twice to hospital with features suggestive of adrenal crisis requiring intravenous hydrocortisone and Intravenous fluids for improvement. The time interval between the first and second episode of adrenal crisis was 4 months. ACTH or CRH stimulation tests were not done during the follow-ups. During both these episodes of adrenal crisis she had no other precipitating factors such as fever, diarrhea or any infection.The diagnosis of adrenal crisis was considered based on the clinical features (vomiting, abdominal pain hypotension, weight loss) in the setting of underlying primary adrenal insufficiency. Details of previous biochemical investigations (sodium, potassium, plasma glucose or arterial blood gas analysis) reports during the admission for adrenal crisis were not available with the patient and hence could not be evaluated.Due to recurrent episodes of crisis the dose of prednisolone was increased to 10mg in the morning and 5mg in the evening. Even then she continued to have persistence of symptoms with progressive weight loss, for which she was referred for further evaluation. However, she was not evaluated for malabsoption or any gastro intestinal related other disorders to rule out possibility of poor intestinal absorption of prednisolone. On the other hand she did not have symptoms of alerted bowel habits (on and off diarrhea or constipation).During evaluation at the time of present admission, she was a thin build lady with hyper-pigmentation of the oral mucosa, palmar creases of both hands and extensor aspects of both arms with no vitiligo. Her supine neck examination showed a WHO grade -II diffuse thyromegaly and there were no obvious signs of thyrotoxicosis (fine tremor, prominence of eye balls) and there was no thyroid bruit. Her supine blood pressure was 100/70 mmHg and on standing, the blo...

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High Prevalence of Thyroid Autoimmunity in Idiopathic Addison's Disease

Cited by 22 publications

References 11 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

Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease

Delayed Diagnosis of Graves’ Thyrotoxicoisis Presenting as Recurrent Adrenal Crisis in Primary Adrenal Insufficiency

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