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Clinical and immunological characteristics of Autoimmune Addison's disease: a nationwide Swedish multicenter study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Science for Life Laboratory, SciLifeLab. Karolinska Inst, Ctr Mol Med, Dept Med Solna, SE-17176 Stockholm, Sweden.
Karolinska Inst, Dept Mol Med & Surg, SE-17176 Stockholm, Sweden.
Umea Univ, Dept Publ Hlth & Clin Med, SE-90736 Umea, Sweden.
Karolinska Inst, Ctr Mol Med, Dept Med Solna, SE-17176 Stockholm, Sweden.
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2017 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 102, no 2, p. 379-389Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.

OBJECTIVE: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.

DESIGN, SETTING AND PARTICIPANTS: Cross sectional, population-based study. 660 AAD patients were included utilizing the Swedish Addison Registry (SAR) 2008-2014. When analyzing cardiovascular risk factors, 3,594 individuals from the population-based survey in Northern Sweden, MONICA (MONItoring of Trends and Determinants of CArdiovascular Disease), served as controls.

MAIN OUTCOME MEASURE: Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.

RESULTS: Sixty percent of the SAR cohort consisted of females. Mean age at diagnosis was significantly higher for females than for males (36.8 vs. 31.1 years). The proportion of 21-hydroxylase autoantibody positive patients was 83% and 62% of patients had one or more associated autoimmune diseases, more frequently coexisting in females (p<0.0001). AAD patients had lower BMI (p<0.0001) and prevalence of hypertension (p=0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of patients; with the mean dose 28.1±8.5 mg/day. The mean hydrocortisone equivalent dose normalized to body surface was 14.8±4.4 mg/m(2)/day. Higher hydrocortisone equivalent dose was associated with higher incidence of hypertension (p=0.046).

CONCLUSIONS: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients do not have increased prevalence of overweight, hypertension, T2DM or hyperlipidemia. However, high glucocorticoid replacement doses may be a risk factor for hypertension.

Place, publisher, year, edition, pages
Oxford University Press, 2017. Vol. 102, no 2, p. 379-389
National Category
Medical and Health Sciences Endocrinology and Diabetes
Research subject
Endocrinology and Diabetology
Identifiers
URN: urn:nbn:se:uu:diva-318344DOI: 10.1210/jc.2016-2522ISI: 000397240900009PubMedID: 27870550OAI: oai:DiVA.org:uu-318344DiVA, id: diva2:1084350
Funder
EU, FP7, Seventh Framework Programme, 201167Novo Nordisk, NNF13OC0005975 NNF15OC0015922 NNF14OC0011003Åke Wiberg FoundationTore Nilsons Stiftelse för medicinsk forskningMarianne and Marcus Wallenberg FoundationSwedish Society of MedicineTorsten Söderbergs stiftelseRagnar Söderbergs stiftelseSwedish Research CouncilThe Karolinska Institutet's Research FoundationSwedish Society for Medical Research (SSMF)Stockholm County CouncilAvailable from: 2017-03-24 Created: 2017-03-24 Last updated: 2019-02-26Bibliographically approved

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Dalin, FridaRönnelid, JohanIsaksson, MagnusHalldin Stenlid, MariaGustafsson, JanGebre-Medhin, Gennet

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Dalin, FridaRönnelid, JohanIsaksson, MagnusHalldin Stenlid, MariaGustafsson, JanGebre-Medhin, Gennet
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Dermatology and VenereologyScience for Life Laboratory, SciLifeLabClinical ImmunologyAutoimmunityPaediatric Inflammation Research
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