uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Clues for early detection of autoimmune Addison's disease - myths and realities
Univ Bergen, Dept Clin Med, Bergen, Norway..
Akershus Univ Hosp, Div Med, Lorenskog, Norway..
Akershus Univ Hosp, Div Med, Lorenskog, Norway.;Univ Oslo, Akershus Univ Hosp, Inst Clin Med, Lorenskog, Norway..
Show others and affiliations
2018 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 2, p. 190-199Article in journal (Refereed) Published
Abstract [en]

Background: Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce.

Objective: Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD.

Material and Methods: A multicentre retrospective study including 272 patients diagnosed with AAD at hospitals in Norway and Sweden during 1978-2016. Scrutiny of medical records provided patient data and laboratory values.

Results: Low sodium occurred in 207 of 247 (84%), but only one-third had elevated potassium. Other common nonendocrine tests were largely normal. TSH was elevated in 79 of 153 patients, and hypoglycaemia was found in 10%. Thirty-three per cent were diagnosed subsequent to adrenal crisis, in whom electrolyte disturbances were significantly more pronounced (P < 0.001). Serum cortisol was consistently decreased (median 62 nmol L-1 [1-668]) and significantly lower in individuals with adrenal crisis (38 nmol L-1 [2-442]) than in those without (81 nmol L-1 [1-668], P < 0.001).

Conclusion: The most consistent biochemical finding of untreated AAD was low sodium independent of the degree of glucocorticoid deficiency. Half of the patients had elevated TSH levels. Only a minority presented with marked hyperkalaemia or other nonhormonal abnormalities. Thus, unexplained low sodium and/or elevated TSH should prompt consideration of an undiagnosed AAD, and on clinical suspicion bring about assay of cortisol and ACTH. Presence of 21-hydroxylase autoantibodies confirms autoimmune aetiology. Anticipating additional abnormalities in routine blood tests may delay diagnosis.

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 283, no 2, p. 190-199
Keywords [en]
Addison, adrenal insufficiency, autoimmune disease, cortisol, electrolytes, endocrinology
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-349836DOI: 10.1111/joim.12699ISI: 000425830100007PubMedID: 29098731OAI: oai:DiVA.org:uu-349836DiVA, id: diva2:1204124
Funder
Swedish Research CouncilTorsten Söderbergs stiftelseRagnar Söderbergs stiftelseStockholm County CouncilThe Karolinska Institutet's Research FoundationSwedish Society for Medical Research (SSMF)Swedish Society of MedicineÅke Wiberg FoundationAvailable from: 2018-05-07 Created: 2018-05-07 Last updated: 2018-05-07Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Isaksson, Magnus

Search in DiVA

By author/editor
Isaksson, Magnus
By organisation
Autoimmunity
In the same journal
Journal of Internal Medicine
Endocrinology and Diabetes

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 35 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf